王凯阳,宁怡,闵轩,谢翔

• 1:新疆医科大学第一附属医院(第一临床医学院)心脏中心
• 2:新疆医科大学第四附属医院心脏中心

摘要(Abstract)：

目的 比较经皮冠状动脉介入治疗（PCI）、冠状动脉旁路移植术（CABG）和最佳药物治疗（OMT）对冠状动脉慢性完全闭塞（CTO）病变的疗效。方法 计算机检索PubMed、EMBASE、TheCochraneLibrary、CNKI、VIP、ChiCTR和WanFangData数据库，搜集关于PCI、CABG和OMT治疗CTO病变疗效比较的队列研究和随机对照试验（RCT）。检索时限均为建库至2021年12月1日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后，采用R3.6.2软件进行网状Meta分析。结果 共纳入33项研究，涉及29项队列研究和4项RCT，共计21 889例患者。在主要不良心血管事件（MACE）发生率方面，三种治疗概率排序第一位的是PCI(53%)，第二位是CABG(47%)，第三位是OMT(92%)；在全因死亡（ACM）发生率方面，三种治疗排序第一位的是CABG(92%)，第二位是PCI(92%)，第三位是OMT(100%)；在血运重建（RV）发生率方面，三种治疗排序第一位的是CABG(100%),PCI(50%)和OMT(50%)并列第二位；在心肌梗死（MI）发生率方面，三种治疗排序第一位的是CABG(98%)，第二位是PCI(97%)，第三位是OMT(99%)；在心原性死亡（CM）发生率方面，三种治疗排序中第一位概率最高的是PCI(90%)，第二位是CABG(90%)，第三位是OMT(100%)；在主要不良心脑血管事件（MACCE）发生率方面，三种治疗排序第一位的是CABG(59%)，第二位是PCI(58%)，第三位是OMT(95%)。CTO病变三种治疗方式的累积排序曲线下面积（SUCRA）显示：对于ACM、RV、MI和MACCE发生率，CABG>PCI>OTM；对于MACE和CM发生率，PCI>CABG>OTM。结论 PCI能降低CTO病变患者MACE和CM发生率，疗效排在第一位；CABG能降低CTO病变患者ACM、RV、MI和MACCE发生率，疗效排在第一位。受纳入研究数量和质量的限制，上述结论尚待更多高质量研究予以验证。

关键词(KeyWords)： 慢性完全闭塞病变;经皮冠状动脉介入治疗;冠状动脉旁路移植术;最佳药物治疗;网状Meta分析

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金面上项目（82170345）

作者(Author): 王凯阳,宁怡,闵轩,谢翔

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