CAJ | 학술논문

目的：经皮冠状动脉介入治疗（PCI）以及小切口冠状动脉旁路移植术（MIDCAB）是目前治疗孤立的冠状动脉前降支基底部狭窄的两种常用方法。为了更好地衡量两种方法的术后疗效，我们利用现有的临床数据进行这一系统评价和Meta分析。方法计算机检索PubMed、EMBASE以及Cochrane，收集公开发表的有关对比PCI和MIDCAB术后疗效的相关文献，提取相关数据，并用Stata12.0软件进行数据分析。结果共纳入7例随机对照临床试验，总计纳入928例，其中PCI组489例，MIDCAB组439例。荟萃分析研究结果发现PCI组与MIDCAB组相比术后的靶血管再血管化率[相对危险度=3.75，95%可信区间：2.3~6.11， P<0.01]明显高于后者，且差异有统计学意义，而对于全因死亡[相对危险度=0.86，95%可信区间：0.56~1.32，P=0.483]、主要心脑血管不良事件发生率（MACCE）[相对危险度=1.64，95%可信区间：0.57~4.71，P=0.355]两者之间的差异无统计学意义。结论MIDCAB治疗前降支基底部狭窄的临床疗效部分优于PCI。
목적：경피관상동맥개입치료（PCI）이급소절구관상동맥방로이식술（MIDCAB）시목전치료고립적관상동맥전강지기저부협착적량충상용방법。위료경호지형량량충방법적술후료효，아문이용현유적림상수거진행저일계통평개화Meta분석。방법계산궤검색PubMed、EMBASE이급Cochrane，수집공개발표적유관대비PCI화MIDCAB술후료효적상관문헌，제취상관수거，병용Stata12.0연건진행수거분석。결과공납입7례수궤대조림상시험，총계납입928례，기중PCI조489례，MIDCAB조439례。회췌분석연구결과발현PCI조여MIDCAB조상비술후적파혈관재혈관화솔[상대위험도=3.75，95%가신구간：2.3~6.11， P<0.01]명현고우후자，차차이유통계학의의，이대우전인사망[상대위험도=0.86，95%가신구간：0.56~1.32，P=0.483]、주요심뇌혈관불량사건발생솔（MACCE）[상대위험도=1.64，95%가신구간：0.57~4.71，P=0.355]량자지간적차이무통계학의의。결론MIDCAB치료전강지기저부협착적림상료효부분우우PCI。
Objective Percutaneous intervention(PCI)and minimally invasive direct coronary bypass grafting(MIDCAB)are the two well ac-cepted treatments for stenosis of the proximal left anterior descending artery. In order to better evaluate the therapeutic efficacy between these two methods,we performed a systemic review and meta-analysis of these studies. Methods PubMed,EMBASE and Cochrane were searched,and relat-ed data were retrieved. Stata12.0 was used to perform the meta-analysis. Results Totally 7 studies and 928 patients were recruited in this study,in-cluding 489 in PCI group and 439 in MIDCAB group. The results of meta-analysis revealed that patients in PCI group had a higher rate of repeat re-vascularization[relative risk(RR)=3.75,95%CI:2.3-6.11,P<0.01].No significant difference was found in neither all-cause mortality[RR=0.86, 95%CI:0.56-1.32,P=0.483]nor main adverse cardiovascular and cerebrovascular events(MACCE)[RR=1.64,95%CI:0.57-4.71,P=0.355]. Conclusion The therapeutic efficacy of MIDCAB were partially better than that of PCI.