预防性经皮冠状动脉介入治疗术对多支血管病变ST段抬高型心肌梗死患者预后影响的Meta分析  

Prognostic Effects of Preventive Percutaneous Coronary Intervention in ST-segment Elevation Myocardial Infarction Patients with Multivessel Disease: A Meta-analysis

作　　者：樊刚[1] 王忠[2] 王丽[2] 段军仓[2] 黄磊[1] 李小雷[1] 

机构地区：[1]石河子大学医学院,新疆维吾尔自治区石河子市832002 [2]石河子大学医学院第一附属医院心内二科

出　　处：《中国全科医学》2016年第25期3120-3128,共9页Chinese General Practice

摘　　要：目的系统评价预防性经皮冠状动脉介入治疗术(PCI)对多支血管病变ST段抬高型心肌梗死(STEMI)患者预后的影响。方法系统检索Pub Med,EMbase,Web of Science,NEJM,中国知网(CNKI)、CBM中关于PCI对多支血管病变STEMI患者预后影响的文献,检索时间均为2001年1月—2015年7月,并根据纳入文献的参考文献进行手工检索。采用Rev Man 5.3软件和Stata 11.0统计软件对最终纳入文献进行Meta分析,比较预防性PCI组和单纯罪犯血管PCI组患者的主要心血管不良事件(MACE)发生率、死亡率、再发心肌梗死率、再次PCI率、行冠状动脉旁路移植术(CABG)率。结果最终纳入合格文献9篇,总样本量为1 650例,均为英文文献。Meta分析结果显示:(1)预防性PCI组患者的MACE发生率低于单纯罪犯血管PCI组,差异有统计学意义〔OR(95%CI)=0.46(0.32,0.67),P<0.05〕。亚组分析结果显示,样本量>200例亚组〔OR(95%CI)=0.47(0.28,0.78),P<0.05〕、样本量≤200例亚组〔OR(95%CI)=0.46(0.25,0.85),P<0.05〕、随访时间>1年亚组〔OR(95%CI)=0.45(0.23,0.88),P<0.05〕、随访时间≤1年亚组〔OR(95%CI)=0.49(0.30,0.78),P<0.05〕中预防性PCI患者的MACE发生率均低于单纯罪犯血管PCI患者,差异有统计学意义。(2)预防性PCI组患者的死亡率低于单纯罪犯血管PCI组,差异有统计学意义〔OR(95%CI)=0.52(0.35,0.77),P<0.05〕。(3)两组患者的再发心肌梗死率比较,差异无统计学意义〔OR(95%CI)=0.67(0.30,1.51),P>0.05〕。亚组分析结果显示,样本量≥149例亚组〔OR(95%CI)=0.54(0.25,1.15),P>0.05〕、样本量<149例亚组〔OR(95%CI)=1.14(0.18,7.11),P>0.05〕、随访时间>1年亚组〔OR(95%CI)=0.85(0.12,6.00),P>0.05〕、随访时间≤1年亚组〔OR(95%CI)=0.69(0.27,1.72),P>0.05〕中两组患者的再发心肌梗死率比较,差异均无统计学意义。(4)预防性PCI组患者的再次PCI率低于单纯罪犯血管PCI组,差异有统计学意义〔OR(95%CI)=0.37(0.28,0.50),P<0.05〕。(5)两组患者的行CABG�Objective To assess the prognostic effects of preventive percutaneous coronary intervention（ PCI） in ST- segment elevation myocardial infarction（ STEMI） patients with multivessel disease systematically. Methods We systematically searched databases such as Pub Med,EMbase,Web of Science,NEJM,CNKI,and CBM from January,2001 to July,2015 to collect relevant literatures related with the prognostic effects of PCI in STEMI, and made manual retrieval of references according to the selected references. We made a meta- analysis of the final selected literatures by Rev Man 5. 3 and Stata 11. 0statistical software so as to compare the incidence rate,mortality rate,recurrent myocardial infarction rate,re- PCI rate,and coronary artery bypass grafting（ CABG） rate of major adverse coronary events（ MACE） of patients between preventive PCI group and culprit vessel- only PCI group. Results The total sample size was 1 650 cases,of which 9 qualified references were finally selected and all were English literatures. Meta analysis showed that：（ 1） MACE incidence rate of the preventive PCI group was significantly lower than that of the culprit vessel- only PCI group 〔OR（ 95% CI） = 0. 46（ 0. 32,0. 67）, P〈0. 05 〕.Analytical results of the subgroups were shown as follows： subgroup of sample size 200 〔OR（ 95% CI） = 0. 47（ 0. 28,0. 78）,P〈0. 05〕,subgroup of sample size≤200 〔OR（ 95% CI） = 0. 46（ 0. 25,0. 85）,P〈0. 05 〕,subgroup of follow- up time 1 year 〔OR（ 95% CI） = 0. 45（ 0. 23,0. 88）, P〈0. 05 〕, subgroup of follow- up time ≤ 1 year 〔OR（ 95% CI） = 0. 49（ 0. 30,0. 78）,P〈0. 05〕,MACE incidence rate of the preventive PCI patients in the subgroups was significantly lower than that of the culprit vessel- only PCI group.（ 2） Mortality rate of patients in preventive PCI group was significantly lower than that of the culprit vessel- only PCI group 〔OR（ 95% CI） = 0. 52（ 0. 35,0. 77）,P〈0. 05〕.（ 3）There was no significant difference in

关 键 词：心肌梗死 血管成形术 气囊 冠状动脉 预后 META分析 

分 类 号：R542.22[医药卫生—心血管疾病]