| Objective: As one of the world’s most one of the leading causes of death and the exploration of strategy in the treatment of coronary heart disease in constant progress,treatment from drug therapy to coronary artery bypass surgery and percutaneous coronary artery stent implantation,which also experienced from bare-metal stents to the progress of drug-eluting stents(DES),through the different experimental method in clinical research on comparing different treatments,This paper tries to summarize the experience and provide guidance for the treatment of patients with coronary heart disease.The purpose of this study was to analyze the results of existing randomized trials to provide a reference for the selection of treatment methods for patients with multi-branch coronary artery disease.Methods:Selection by using the method of classic arms meta-analysis,coronary heart disease(CHD)multivessel coronary artery lesions merger or patients with the left main lesion,based on the random distribution of coronary artery bypass surgery or percutaneous coronary artery stent implantation,more than 5 years of follow-up,with all-cause mortality,MACCE as the endpoint,compared to two kinds of treatments for patients survival benefits.In this paper,the subjects of"冠心病","心肌血管重建术"and"经皮冠状动脉介入治疗"were combined with their corresponding free words to search CNKI,VIP,Wanfang database and China Biomedical Literature Database.In terms of"Coronary Disease","Coronary Artery Bypass"and"Percutaneous Coronary Intervention",Pub Med,Embase,and Cochrane Library were searched.The publication time was limited to 10 years from January 2011 to December 2020,and relevant literature of randomized controlled trials was retrieved.Reasonable inclusion and exclusion criteria were developed to screen out studies with a follow-up period of more than 5 years.Data were extracted.Based on the requirements of the Prisma statement,Rev Man 5.3 software was used for meta-analysis,and literature quality was scored using the Cochrane risk assessment tool.Forest plots and funnel plots were drawn,and P<0.05 was taken as the standard of statistical significance.The possible bias was comprehensively analyzed to obtain results with high reliability and then discussed.Results: A total of 2902 pieces of literature were initially retrieved.After screening according to inclusion and exclusion criteria,a total of 4061 patients from 3 studies in 5kinds of literature were included in this meta-analysis.Of these,2026 patients were randomized to undergo percutaneous coronary stenting and 2035 to undergo coronary artery bypass grafting.Results of the meta-analysis showed that there were no significant differences in baseline data,including age,gender,Euro score,smoking status,diabetes,dyslipidemia,previous MI,and previous stroke status between the two groups of patients included in the study,but there were more males than females in the patients,which was statistically significant.At 5 years of follow-up,patients treated with percutaneous coronary artery bypass grafting had higher all-cause mortality(P=0.0001,95%CI=1.22--1.82),MACCE rates(P < 0.00001,95%CI=1.56 to 2.06),non-cardiac mortality(P <0.00001,95%CI=1.28 to 1.80),MI incidence(P < 0.00001,95%CI= 2.27 to 4.09),and revascularization(P < 0.00001,95%CI= 2.27 to 4.09).95%CI=2.15 to 3.05),and the results for stroke incidence were reversed(P=0.03,95%CI=0.45 to 0.95).Conclusions: From the most recent systematic reviews and meta-analyses,the overall evidence from randomized clinical trials indicates that coronary artery bypass grafting is superior to percutaneous coronary stenting as a choice of invasive treatment for patients with multiple coronary artery disease with or without left main artery disease in stable angina pectoris.These findings may be useful for cardiologists,cardiac surgeons,and patients with the multi-vessel disease to make clinical decisions. |
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