Introduction

Coronary artery disease (CAD) is a leading cause of morbidity and mortality worldwide. A large number of studies assessed the clinical impact of coronary revascularization in patients with chronic coronary syndrome (CCS), yet with heterogeneous results. Therefore, the aim of this meta-analysis was to provide a quantitative comparison between myocardial revascularization (REVASC) and optimal medical treatment (OMT) alone.

Methods

Pertinent studies were searched for in PubMed/Medline and until 12/03/2023. Randomized controlled trials that comparing REVASC to OMT reporting clinical outcomes were selected according to PRISMA guidelines. The primary outcome was cardiovascular death. Two investigators independently assessed study quality and extracted data.

Results

Twenty-eight randomized controlled studies (RCTs) including 20692 patients were included in this meta-analysis. The rate of cardiovascular mortality was significantly lower among patients treated with myocardial revascularization [risk ratio (RR) 0.79, 95% CI 0.69-0.90]. Age (p=0.03), multivessel disease (p<0.001), and follow-up duration (p=0.001) were significant moderators of CV mortality. Subgroup analyses showed a larger benefit in patients treated with drug-eluting stents and those without chronic total occlusion. Among secondary outcomes, myocardial infarction was less frequent in the REVASC group (RR=0.74; p<0.001), while no significant difference was found for all-cause mortality (p=0.09) nor stroke (p=0.26).

Conclusions

The present analysis showed lower rates of CV mortality and myocardial infarction in CCS patients treated with myocardial revascularization compared to OMT. This benefit was larger with increasing follow-up duration. Personalized treatment based on patient characteristics and lesion complexity may optimize clinical outcomes in patients with CCS.

中文翻译：

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冠状动脉血运重建对慢性冠状动脉综合征药物治疗的临床影响：系统评价和荟萃分析

介绍

冠状动脉疾病（CAD）是全世界发病和死亡的主要原因。大量研究评估了冠状动脉血运重建对慢性冠状动脉综合征（CCS）患者的临床影响，但结果各异。因此，本荟萃分析的目的是提供心肌血运重建（REVASC）和单独最佳药物治疗（OMT）之间的定量比较。

方法

在 PubMed/Medline 中检索相关研究直至 2023 年 12 月 3 日。根据 PRISMA 指南选择比较 REVASC 与 OMT 报告临床结果的随机对照试验。主要结局是心血管死亡。两名研究人员独立评估研究质量并提取数据。

结果

这项荟萃分析纳入了 28 项随机对照研究 (RCT)，其中包括 20692 名患者。接受心肌血运重建治疗的患者心血管死亡率显着降低[风险比 (RR) 0.79，95% CI 0.69-0.90]。年龄 (p=0.03)、多支血管疾病 (p<0.001) 和随访时间 (p=0.001) 是心血管死亡率的显着调节因素。亚组分析显示，接受药物洗脱支架治疗的患者和没有慢性完全闭塞的患者获益更大。在次要结局中，REVASC 组心肌梗死发生率较低（RR=0.74；p<0.001），而全因死亡率（p=0.09）和卒中（p=0.26）没有发现显着差异。

结论

目前的分析显示，与 OMT 相比，接受心肌血运重建治疗的 CCS 患者的 CV 死亡率和心肌梗死率较低。随着随访时间的延长，这种益处会更大。基于患者特征和病变复杂性的个性化治疗可能会优化 CCS 患者的临床结果。