手术消融和左心耳闭塞在房颤患者行冠状动脉搭桥术中的疗效：一项网络荟萃分析。

IF 2.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of cardiology Pub Date : 2025-03-01 DOI:10.1016/j.jjcc.2025.01.011

Ahmed K. Awad MD , Mohammed A. Elbahloul MD , Aliaa Gamal MD , Amir N. Attia MD , Sarah M. Hamed MD , Ahmed I. Elsekhary MD , Michel Pompeu Sá MD, MSc, MHBA, PhD

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引用次数: 0

摘要

背景：心房颤动（AF）是一种常见的心律失常，大大增加了卒中的风险。这种风险在心脏手术期间和之后都会增加，例如冠状动脉旁路移植术（CABG）。人们越来越关注非药物治疗，如左心耳闭塞（LAAO）和手术消融，旨在提高即时和长期的术后效果。目的：探讨手术消融（SA）、LAAO或两者同时应用于房颤搭桥患者的疗效。方法：检索PubMed、Scopus、Cochrane Library和WOS四个电子数据库。我们使用R语言和元洞察软件的“netmeta”和“netrank”包分析数据。合并结果报告为随机效应方法的平均差异或风险比（RR），置信区间为95% %。结果：共纳入16项研究，纳入594,312例患者。CABG- laao与单独CABG和CABG- sa的30天死亡率差异无统计学意义，RR分别为1.70 （95%CI 0.38-7.61）和0.62 （95%CI 0.10-3.94）。然而，与单独CABG相比，CABG- sa + LAAO、CABG-LAAO和CABG- sa的长期死亡风险显著降低，RR分别为0.75 （95%CI 0.57-0.98）、0.78 （95%CI 0.65-0.94）和0.73 （95%CI 0.61-0.88）。CABG- sa + 与单独CABG相比，LAAO、CABG-LAAO和CABG- sa降低了短期卒中的风险，RR分别为0.73 （95%CI 0.43-1.24）、0.93 （95%CI 0.78-1.11）和1.01 （95%CI 0.75-1.36）。此外，只有CABG-SA + LAAO和CABG-LAAO在长期卒中和心力衰竭住院方面具有统计学意义，而CABG-SA无统计学差异。此外，在30天再住院、主动脉内球囊泵支持和出血风险方面，我们的干预措施没有统计学上的显著差异。结论：房颤患者行冠脉搭桥，无论是单独行冠脉搭桥还是单独行冠脉搭桥，或同时行冠脉搭桥均可显著降低短期和长期死亡率及短期卒中风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Efficacy of surgical ablation and left atrial appendage occlusion in patients with AF undergoing coronary artery bypass grafting: A network meta-analysis

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Efficacy of surgical ablation and left atrial appendage occlusion in patients with AF undergoing coronary artery bypass grafting: A network meta-analysis

Background

Atrial fibrillation (AF) is a prevalent cardiac arrhythmia that greatly elevates the risk of stroke. This risk increases both during and after cardiac procedures, such as coronary artery bypass grafting (CABG). There is an increasing interest in non-pharmacological treatments such as left atrial appendage occlusion (LAAO) and surgical ablation, intending to enhance both immediate and long-term postoperative results.

Objective

To investigate the efficacy of surgical ablation (SA), LAAO, or both in patients with AF undergoing CABG.

Methods

We searched four electronic databases: PubMed, Scopus, Cochrane Library, and WOS. We analyzed data using R language and “netmeta” and “netrank” packages of meta-insight software. Pooled outcomes were reported as mean difference or risk ratio (RR) with 95 % confidence interval (CI) in a random effect method.

Results

A total of 16 studies were included with 594,312 patients included. The 30-day mortality showed a non-statistically significant difference between CABG-LAAO compared to CABG alone and CABG-SA with RR of 1.70 (95%CI 0.38–7.61) and 0.62 (95%CI 0.10–3.94). However, compared to CABG alone, CABG-SA + LAAO, CABG-LAAO, and CABG-SA had significantly lower risk of long-term mortality with RR 0.75 (95%CI 0.57–0.98), 0.78 (95%CI 0.65–0.94), and 0.73 (95%CI 0.61–0.88), respectively. CABG-SA + LAAO, CABG-LAAO, and CABG-SA reduced the risk of short-term stroke compared to CABG alone with RR of 0.73 (95%CI 0.43–1.24), 0.93 (95%CI 0.78–1.11), and 1.01 (95%CI 0.75–1.36), respectively. Moreover, only CABG-SA + LAAO and CABG-LAAO showed a statistically significant reduction in long term stroke and hospitalization due to heart failure while CABG-SA showed no statistically significant difference. Furthermore, there was no statistically significant difference between our interventions in terms of 30-day rehospitalization, intra-aortic balloon pump support, and risk of hemorrhage.

Conclusion

Among patients with AF undergoing CABG, whether undergoing SA alone or LAAO alone or both showed significant clinical outcomes such as reduced risk of both short- and long-term mortality and short-term stroke.

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来源期刊

Journal of cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

4.90

自引率

8.00%

发文量

202

审稿时长

29 days

期刊介绍： The official journal of the Japanese College of Cardiology is an international, English language, peer-reviewed journal publishing the latest findings in cardiovascular medicine. Journal of Cardiology (JC) aims to publish the highest-quality material covering original basic and clinical research on all aspects of cardiovascular disease. Topics covered include ischemic heart disease, cardiomyopathy, valvular heart disease, vascular disease, hypertension, arrhythmia, congenital heart disease, pharmacological and non-pharmacological treatment, new diagnostic techniques, and cardiovascular imaging. JC also publishes a selection of review articles, clinical trials, short communications, and important messages and letters to the editor.