终末期肾脏疾病患者的选择:PCI?或CABG?

   背景
   终末期肾脏疾病(ESRD)患者冠状动脉血运重建选择策略目前由于缺乏相关随机临床试验仍然存在争议。随之PCI技术的提高,包括药物洗脱支架的改进,使得PCI术普及度明显增高。该荟萃分析旨在比较ESRD接受PCI或CABG的死亡率。
   方法
   在PubMed中检索相关文献,无时间限制,比较ESRD接受PCI和CABG的临床疗效,有19项研究符合要求。主要临床终点30天和12个月的全因死亡率,同时计算第24个月和低36个月的长期死亡率。进行亚组分析比较PTCA对CABG和PCI对CABG的临床疗效。效应变量为比值比(OR)和可信区间(CI),使用随机效应模型对其进行评估。
   结果
   研究总共纳入32696例患者, 17385例患者接受PCI,15311例接受CABG。与CABG组相比,PCI相关的再灌注治疗策略(无论是PCI组或PTCA组)30天死亡率显著降低,但这种获益并没有维持,在第24个月和36个月,CABG组显示出明显的优势。使用敏感性分析提出两个最大的研究组(n =30090)干扰后表明CABG组远期死亡率仍然较低。
   结论
   研究表明,ESRD选择冠状动脉血管重建策略时,选择PCI显示短期全因死亡风险较低,而选择CABG则远期全因死亡风险较低。

英文原文:

PCI or Coronary Artery Bypass Graft: Implications in End-Stage Renal Disease Patients

   Background
   Mode of coronary revascularization in end stage renal disease (ESRD) patients remains a controversy due to lack of randomized clinical trials. Improvements in PCI technology including use of drug eluting stents has resulted in wide spread use of PCI in general population. We therefore conducted a meta-analysis comparing the mortality outcomes in ESRD patients undergoing PCI or CABG.
   Methods
   A comprehensive time unlimited PubMed search revealed 19 studies comparing PCI and CABG in ESRD patients. Primary clinical endpoint was all-cause mortality at 30 days and 12 months follow-up. Long term mortality (24 and 36 months) was also calculated. Subgroup analyses were performed on patients undergoing PTCA vs. CABG and PCI vs. CABG. Odds ratio (OR) and confidence interval (CI) were estimated using random effects model.
   Results
   Of the 32696 patients analyzed 17385 underwent PCI and 15311 underwent CABG. Revascularization with PCI was associated with decreased mortality at 30 days in both PTCA and PCI groups compared to CABG. However, this mortality benefit was not maintained at subsequent follow-up (24, 36 months) with CABG being superior among all groups. In a sensitivity analysis excluding the 2 largest studies (n=30090), CABG remained associated with lower mortality at long term follow-up (Table).
   Conclusion
   In ESRD patients undergoing coronary revascularization with PCI, short-term mortality was low however, at longer-term follow-up; CABG was associated with a lower risk of all-cause death.


    2013/3/11 9:18:25     访问数:667
    转载请注明:内容转载自365医学网

大家都在说       发表留言

客服中心 4000680365  service@365yixue.com
编辑部   editor@365yixue.com

365医学网 版权所有 © 365heart All Rights Reserved.

京ICP备12009013号-1
京卫网审[2013]第0056号
京公网安备110106006462号
京ICP证041347号
互联网药品信息服务资格证书(京)-经营性-2018-0016  
搜专家
搜医院
搜会议
搜资源
 
先点击
再选择添加到主屏