冠状动脉慢性完全闭塞病变患者PCI术后主要不良心血管事件影响因素的Meta分析  

Meta analysis of prognostic factors for major adverse cardiovascular events in patients with chronic total occlusion of coronary artery after PCI

作　　者：王凯阳[1] 闵轩 马依彤[1] 谢翔[1] WANG Kaiyang;MIN Xuan;MA Yitong;XIE Xiang(Department of Cardiology,First Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang 830011,China)

机构地区：[1]新疆医科大学第一附属医院心脏中心,新疆乌鲁木齐市830011

出　　处：《中国动脉硬化杂志》2022年第9期778-786,820,共10页Chinese Journal of Arteriosclerosis

基　　金：国家自然科学基金项目(81770235)。

摘　　要：[目的]系统评价冠状动脉慢性完全闭塞病变(CTO)患者经皮冠状动脉介入治疗(PCI)术后主要不良心血管事件(MACE)的影响因素。[方法]计算机检索PubMed、EMBASE、the Cochrane Library、CNKI、VIP及WanFang Data数据库,搜集关于CTO患者PCI术后MACE影响因素的队列研究,检索时限均为建库至2021年10月。由两名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用R3.6.2软件进行Meta分析。[结果]共纳入30项队列研究,包含25002名CTO患者。Meta分析结果显示:8个影响因素具有统计学意义,分别为年龄(RR=1.06,95%CI为1.01~1.10,P=0.01)、男性(RR=1.68,95%CI为1.17~2.42,P<0.01)、既往冠状动脉搭桥术(RR=1.50,95%CI为1.12~1.99,P<0.01)、糖尿病史(RR=1.51,95%CI为1.15~1.99,P<0.01)、肾功能不全(RR=2.91,95%CI为2.44~3.48,P<0.01)、支架内闭塞病变(RR=2.15,95%CI为1.08~4.31,P=0.03)、PCI成功(RR=0.52,95%CI为0.38~0.72,P<0.01)和最小管腔直径(RR=0.47,95%CI为0.31~0.70,P<0.01)。[结论]当前证据表明,年龄、男性、既往冠状动脉搭桥术、糖尿病史、肾功能不全、支架内闭塞病变是CTO患者PCI术后发生MACE的危险因素,而PCI成功和最小管腔直径是CTO患者PCI术后发生MACE的保护因素。Aim To systematically review the prognostic factors for major adverse cardiovascular events(MACE)in patients with chronic total occlusion(CTO)of coronary artery after percutaneous coronary intervention(PCI).Methods PubMed,EMBASE,the Cochrane Library,CNKI,VIP and WanFang Data databases were electronically searched to collect cohort studies on the prognostic factors for MACE in patients with CTO after PCI from inception to October 2021.Two reviewers independently screened literature,extracted data and assessed risk of bias of included studies.Then,Meta analysis was performed using R3.6.2 software.Results A total of 30 cohort studies were included,including 25002 patients with CTO.The results of Meta analysis showed that there were 8 prognostic factors with statistical significance:age(RR=1.06,95%CI was 1.01~1.10,P=0.01),male(RR=1.68,95%CI was 1.17~2.42,P<0.01),coronary artery bypass grafting history(RR=1.50,95%CI was 1.12~1.99,P<0.01),diabetes history(RR=1.51,95%CI was 1.15~1.99,P<0.01),renal dysfunction(RR=2.91,95%CI was 2.44~3.48,P<0.01),in-stent CTO(RR=2.15,95%CI was 1.08~4.31,P=0.03),successful PCI(RR=0.52,95%CI was 0.38~0.72,P<0.01)and minimal lumen diameter(RR=0.47,95%CI was 0.31~0.70,P<0.01),respectively.Conclusions Current evidence shows that age,male,coronary artery bypass grafting history,diabetes history,renal dysfunction and in-stent CTO were the risk factors for MACE in patients with CTO after PCI.Successful PCI and minimal lumen diameter were the protective factors for MACE in patients with CTO after PCI.

关 键 词：慢性完全闭塞病变 经皮冠状动脉介入治疗 主要不良心血管事件 预后因素 META分析 

分 类 号：R5[医药卫生—内科学] R181[医药卫生—临床医学]