冠状动脉杂交技术对比冠状动脉旁路移植术在冠状动脉再血管化中的meta分析

目的 评价冠状动脉再血管化杂交技术（HCR）与冠状动脉旁路移植术（CABG）在冠心病治疗中的有效性和安全性。方法 检索MEDLINE，EMBASE数据库，中国知网，Corchrane图书馆及二次资源。检索词：杂交技术、冠状动脉旁路移植术、经皮冠状动脉支架置入术、一站式冠状动脉杂交术、分站式冠状动脉杂交术。采用比值比（odd ratio, OR）和95%可信区间（95% confidence interval, CI）作为评价HCR和CABG的主要心脑血管事件发生率（死亡率、卒中发生率、心肌梗死发生率、目标血管再血管化率、主要的心脑血管事件发生率、新发的心房颤动发生率以及红细胞输注率）有无差异的指标；用均数差（median difference，MD）和 95%CI作为评价机械通气时间、ICU时间、总住院时间有无差异的指标。统计学分析应用RevMan 5.2进行异质性检验及Meta分析。结果 在检索到的文献中共有17篇文献满足条件，总计8 608例患者。行HCR的患者和非体外循环CABG的患者比较，在死亡率［OR=0.77, 95%CI（0.42, 1.41）, I2（0%），P=0.39］、心肌梗死发生率［OR=0.78, 95%CI（0.40，1.52）, I2（0%），P=0.47］、卒中发生率［OR=0.67, 95%CI（0.34，1.33）, I2（0%），P＝0.26］、主要的心脑血管事件发生率［OR=0.74, 95%CI（0.53，1.03）, I2（0%），P=0.07］、目标血管再血管化率［OR=2.41, 95%CI（0.91，6.38）, I2（0%），P=0.08］以及新发的心房颤动发生率［OR=0.92, 95%CI（0.70，1.22）, I2（29%），P=0.56］方面差异无统计学意义；在红细胞输注率［OR=-0.16, 95%CI（-0.22，-0.09）, I2（34%），P＜0.01］方面有所降低；在机械通气时间［OR=-6.25，95%CI（-9.01，-5.32）, I2（22%），P＜0.01］、ICU时间［OR=-18.58, 95%CI（-23.65，-13.52）, I2（45%），P＜0.01］、总住院时间［OR=-0.3, 95%CI（-0.46，-0.15）, I2（6%），P＜0.01］方面，时间均有所缩短。结论 HCR安全可行，且较CABG具有一定优势。

Hybrid coronary revascularization versus coronary artery bypass: a meta-analysis

Objective To evaluate the efficacy and safety of coronary revascularization hybridization(HCR)and coronary artery bypass grafting(CABG)in the treatment of coronary heart disease.Methods Databases such as MEDLINE,EMBASE,CNKI,Corchrane library,combined with secondary resource,were searched with the key words being“hybridization,coronary artery bypass grafting,percutaneous coronary stent implantation,one-stop coronary artery hybridization,and staged coronary artery hybridization”.The odd ratio(odd ratio,OR)and 95%confidence interval(95%confidence interval,CI)were adopted to evaluate the incidence of major cardiovascular events in HCR and CABG(mortality,incidence of stroke,incidence of myocardial infarction,target vascular revascularization(TVR),major cardio cerebral vascular events(MCCVEs)and the diference about the incidence of new atrial fibrillation and the rate of red blood cell infusion.The median difference(MD)and 95%CI were used to evaluate the difference between the length of mechanical ventilation time,the time of ICU and the time of total hospitalization.Statistical analysis was performed by RevMan 5.2 for heterogeneity test and Meta analysis.Results A total of 17 experiments met the criteria in the retrieved literature,totaling 8608 patients.There was no significant difference between the mortality(OR=0.77,95%CI0.42,1.41],I 20%],P=0.39);the incidence of myocardial infarction(OR=0.78,95%CI0.40,1.52],I 20%],P=0.47);the incidence of stroke(OR=0.67,95%CI0.34,1.33],I 20%],P=0.26)and the incidence of major cardio cerebral vascular events(OR=0.74,95%CI0.53,1.03],I 20%],P=0.07);the rate of target vascular revascularization(OR=2.41,95%CI0.91,6.38],I 20%],P=0.08)and the incidence of new atrial fibrillation(OR=0.92,95%CI0.70,1.22],I 229%],P=0.56)were not statistically different;The rate of cellular infusion(OR=-0.16,95%CI-0.22,-0.09],I 234%],P<0.01)decreased,and there were statistical differences.And,there were significant differences between mechanical ventilation time(OR=-6.25,95%CI-9.01,-5.32],I 222%],P<0.01);ICU time(OR=-18.58,95%CI-23.65,-13.52],I 245%],P<0.01),and total hospitalization time(OR=-0.3,95%CI-0.46,-0.15],I 26%],P<0.01),and all the time was shortened,which was of great statistical significance.Conclusion It is clear that coronary artery revascularization is safe and feasible with advantages over CABG.