经皮冠状动脉介入与优化药物治疗对稳定型冠心病患者疗效的meta分析

摘要

Objective To compare the efficacy of PCI and OMT in patients with stable coronary artery disease ( SCAD) . Methods The databases of Pubmed, CENTRAL, and CNKI were retrieved with computers for collecting random-ized controlled trials ( RCTs) about the comparison in the efficacy of PCI and OMT published during January 1990 and Decem-ber 2014. After rigorous evaluation on literature quality, the eligible data of RCTs was extracted and given a Meta-analysis u-sing RevMan5. 0 software. Results There were totally 13 RCTs included, and the results of Meta-analysis showed that be-tween PCI and OMT groups, the all-cause-death-events (RR=0. 86, 95%CI:0. 74~1. 00, P=0. 05), and the incidence of cardiac death events (RR=0. 71, 95%CI:0. 47 ~1. 06, P=0. 09), the incidence of nonfatal MI (RR=0. 93, 95%CI:0. 71~1. 22, P=0. 60), the incidence of revascularization (RR=0. 94, 95%CI:0. 71~1. 25, P=0. 68) had no significant difference, but the incidence rate of freedom of angina (RR=1. 18, 95%CI:1. 06~1. 31, P=0. 003) was higher in PCI group than that in OMT group. Conclusion In the treatment of SCAD patients, PCI can significantly improve the incidence of freedom of angina, but it is similar to OMT in the rate of all-cause-death, cardiac death, nonfatal MI, and revasculariza-tion, which shows the clinical advantages of PCI in treatment of SCAD patients.%目的 比较经皮冠状动脉介入治疗( percutaneous coronary intervention, PCI)与优化药物治疗( optimal medical therapy, OMT)对稳定型冠心病( stable coronary artery disease, SCAD)患者的疗效. 方法 应用计算机联网检索PubMed、Cochrane Central Register of Controlled Trials、中国知网( CNKI)等全文数据库,查询1990年1月—2014年12月公开发表的有关PCI和OMT对SCAD疗效的临床随机对照试验( randomized controlled trials, RCTs)研究并进行me-ta分析. 结果 本研究共纳入13 项RCTs,meta分析显示:PCI组与OMT组比较全因病死率( RR=0. 86,95%CI:0. 74~1. 00,P=0. 05)、心源性病死率(RR=0. 71,95%CI:0. 47 ~1. 06,P=0. 09)、非致命性心肌梗死发生率(RR=0. 93,95%CI:0. 71~1. 22,P=0. 60)、再血管化发生率(RR=0. 94,95%CI:0. 71~1. 25,P=0. 68)差异均无统计学意义;PCI组心绞痛缓解发生率(RR=1. 18,95%CI:1. 06~1. 31,P=0. 003)高于OMT组. 结论 PCI治疗心绞痛缓解率较OMT治疗明显提高,但在全因病死率、心源性病死率、非致命性心肌梗死发生率、再血管化发生率方面并无差异,初步显示出PCI的临床优越性.