完全血运重建对合并多支血管病变的急性ST段抬高型心肌梗死患者预后影响的Meta分析  

Meta-analysis of the effect of complete revascularization on the prognosis of patients with acute ST-segment elevation myocardial infarction complicated with multivessel disease

作　　者：严广东 吴璠[2] 杨慧 李彪 Yan Guangdong;Wu Fan;Yang Hui;Li Biao(Department of Cardiovascular Medicine,Guangzhou Red Cross Hospital,Guangzhou 510000,China)

机构地区：[1]广州市红十字会医院心血管内科,广州510000 [2]广州医科大学附属广州市妇女儿童医疗中心心脏中心,广州510623

出　　处：《中国循证心血管医学杂志》2019年第1期24-28,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的系统评价完全血运重建与仅罪犯血管介入治疗合并多支血管病变的急性ST段抬高型心肌梗死患者的临床疗效。方法计算机检索PubMed、EMBASE、Cochrane Library、CBM、CNKI、万方数据库,纳入有关完全血运重建和仅罪犯血管介入治疗合并多支血管病变的急性ST段抬高型心肌梗死预后比较的随机对照研究。由两名评价员按照纳入与排除标准筛选文献,提取资料和评价质量后,采用Cochrane协作网提供的RevMan5.3统计软件进行Meta分析。结果最终纳入11篇随机对照研究,共计3697例患者,其中完全血运重建组1675例,仅罪犯血管经皮冠状动脉介入治疗(PCI)组2022例。Meta分析结果显示,与仅罪犯血管PCI组相比,完全血运重建组在主要心血管事件(MACE)发生率(RR=0.53,95%CI:0.42～0.69,P<0.001)、心血管死亡率(RR=0.46,95%CI:0.30～0.71,P<0.001)、全因死亡率(RR=0.68,95%CI:0.50～0.92,P=0.01)、再次血运重建(RR=0.38,95%CI:0.31～0.47,P<0.001)发生率显著降低,差异有统计学意义;但两组再发急性心肌梗死率无统计学差异(RR=0.74,95%CI:0.54～1.01,P=0.06)。结论在合并多支血管病变的急性ST段抬高型心肌梗死患者的介入治疗中,与仅罪犯血管介入治疗相比,完全血运重建治疗策略是安全有效的,可降低患者的MACE发生率、心血管死亡率、全因死亡率及再次血运重建,改善预后。Objective To evaluate the clinical efficacy of complete revascularization for the patients suffering from acute ST-segment elevated myocardial infarction complicated with multivessel disease.Methods The databases searched included PubMed,Embase,Cochrane Library,CBM,CNKI,Wanfang Database.Randomized controlled trials(RCTs)about the prognosis of complete revascularization versus culprit coronary intervention were included.All selected RCTs were screened by 2 reviewers according to inclusion and exclusion criteria.After extracting data and quality evaluation,meta-analysis was conducted by using RevMan 5.3 software.Results There were 11 included RCTs with 3697 cases,1675 in complete revascularization group and 2022 in culprit coronary intervention group.The result of meta analysis showed that,compared with the culprit coronary intervention group,the incidence about major cardiovascular events(MACE)(RR=0.53,95%CI:0.42~0.69,P<0.001),cardiovascular mortality(RR=0.46,95%CI:0.30~0.71,P<0.001),all-cause mortality(RR=0.68,95%CI:0.50~0.92,P=0.01),and repeat revascularization(RR=0.38,95%CI:0.31~0.47,P<0.001)in the complete revascularization group were lower.The remyocardial infarction between two groups had no statistical difference(RR=0.74,95%CI:0.54~1.01,P=0.06).Conclusion In the treatment of patients with acute ST-segment elevated myocardial infarction and multivessel disease,complete revascularization is safe and effective.It reduced the incidence of MACE,cardiovascular mortality,all-cause mortality and repeat revascularization,which can improve the prognosis of patients.

关 键 词：完全血运重建 罪犯血管介入 急性ST段抬高型心肌梗死 多支血管病变 预后 META分析 

分 类 号：R542.22[医药卫生—心血管疾病]