系统综述

冠状动脉旁路移植术中桡动脉与大隐静脉中期造影结果的比较:基于随机对照试验的meta分析

Published at: 2014年第1卷第8期

Christopher Cao 1 , Su C. Ang 2 , Kevin Wolak 2 , Sheen Peeceeyen 3 , Paul Bannon 4 , Tristan D. Yan 4
1 The Systematic Review Unit, The Collaborative Research (CORE) Group, Sydney, Australia; The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, Australia; Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia
2 The Systematic Review Unit, The Collaborative Research (CORE) Group, Sydney, Australia
3 Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia
4 The Systematic Review Unit, The Collaborative Research (CORE) Group, Sydney, Australia; The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, Australia; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia

摘要

研究背景:目前,大隐静脉(SV)和桡动脉(RA)是常规冠状动脉旁路移植手术(CABG)中与左内乳动脉联合使用最常见的桥血管。本meta分析目的是评估现有的来自随机对照试验(RCT)的证据,比较这两个桥血管中期血管造影的随访结果。 方法:通过检索5个电子数据库得到4个相关且最新的随机对照研究,随访时间都超过3年。血管造影结果的终点包括:完全闭塞、“线样征”、移植物失功及完全通畅。 结果:桡动脉桥中期完全闭塞发生率显著低于大隐静脉桥【6.7% vs. 17.2%;比值比(OR)为0.36;95%置信区间(CI):0.23-0.58;P<0.0001】。桡动脉桥血管造影“线样征”比大隐静脉桥更易被识别(3.1% vs. 0%;OR 5.65;95% CI: 1.21-26.39;P=0.03)。大隐静脉移植失败的发生率则明显高于桡动脉桥(18.8% vs. 9.6%;OR 0.47;95% CI: 0.30-0.72;P=0.0005)。桡动脉桥中期完全通畅率明显高于大隐静脉桥(88.6% vs. 75.8%;OR 3.19;95% CI: 1.42-7.16;P=0.005)。 结论:本meta分析的结果表明,对于严重近端狭窄的患者,CABG术中使用RA相比SV可能具有更好的中期血管造影随访结果。然而,RA与显著增高的“线样征”发生率相关。未来的研究应着眼于收集另外一些症状相关性结果的数据。

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