完全血运重建治疗急性心肌梗死合并多支血管病变效果的系统评价再评价  

Complete Revascularization for Acute Myocardial Infarction and Multivessel Disease:an Overview of Systematic Reviews

作　　者：王哲 赵海滨[3] 汪国梁 马晓娟[2] 殷惠军[2] WANG Zhe;ZHAO Haibin;WANG Guoliang;MA Xiaojuan;YIN Huijun(Graduate School,Beijing University of Chinese Medicine,Beijing 100105,China;Cardiovascular Center,Xiyuan Hospital of China Academy of Chinese Medical Sciences,Beijing 100091,China;Department of Cardiology,Dongfang Hospital,Beijing University of Chinese Medicine,Beijing 100078,China;Department of Traditional Chinese Medicine,Shaoxing People's Hospital,Shaoxing 312099,China)

机构地区：[1]北京中医药大学研究生院,北京市100105 [2]中国中医科学院西苑医院心血管病中心,北京市100091 [3]北京中医药大学东方医院心血管科,北京市100078 [4]浙江省绍兴市人民医院中医科,312099

出　　处：《中国全科医学》2023年第2期142-153,共12页Chinese General Practice

基　　金：国家自然科学基金资助项目(82074418)。

摘　　要：背景对于急性心肌梗死合并多支血管病变的治疗,目前主要有单纯罪犯血管血运重建及完全血运重建两种方法,虽然许多系统评价对比了这两种治疗方法的有效性和安全性,但其质量和结果不尽相同,无法直接应用于临床。目的对完全血运重建治疗急性心肌梗死合并多支血管病变的效果进行系统评价再评价。方法检索PubMed、Cochrane Library和Embase及PROSPERO数据库,搜集对比完全血运重建和单纯罪犯血管血运重建治疗急性心肌梗死合并多支血管病变效果的系统评价或Meta分析,检索时限为建库至2022年2月,无语言及发表状态限制。由2名研究者使用AMSTAR 2量表、GRADE分级系统分别评价其方法学质量和证据质量。结果共纳入25篇符合条件的系统评价/Meta分析。根据AMSTAR 2量表评价结果,纳入研究的方法学质量整体偏低,1篇为高质量,2篇为中质量,22篇为极低质量。25篇文献共涉及8个结局指标,135个证据体,其中8个GRADE分级为高级,17个为中级,其余为低级或极低级。结论相较单纯罪犯血管血运重建,完全血运重建可以改善急性心肌梗死合并多支血管病变患者的部分临床结局,但其安全性有待大样本、高质量临床研究的进一步评估。Background Culprit-only revascularization and complete revascularization are two major treatments for acute myocardial infarction(AMI)with multivessel disease.Many systematic reviews have compared the efficacy and safety of the two treatments,but the review results are inconsistent and cannot be directly applied to clinical practice.Objective To perform an overview of the systematic reviews of the efficacy and safety of complete revascularization versus culprit-only revascularization for AMI with multivessel disease.Methods PubMed,Cochrane Library,Embase and PROSPERO databases were searched from inception to February,2022 for systematic reviews/meta-analyses about complete revascularization versus culprit-only revascularization for AMI with multivessel disease regardless of the language and status of publication.Two researchers independently evaluated the methodological quality and evidence quality of included studies using the AMSTAR 2 and GRADE,respectively.Results A total of 25 systematic reviews or meta-analyses were included.The methodological quality of the included studies was generally low,with one being of high quality,two being of moderate quality,and 22 being of critical low quality.Eight outcomes and 135 evidence bodies(eight were of high quality,17 were of moderate quality,and the rest were of low or very low quality according to the GRADE classification)were identified in the studies in total.Conclusion Compared with culprit-only revascularization,complete revascularization can partially improve clinical outcomes in patients with AMI with multivessel disease,but its safety needs to be further evaluated by high-quality,large-sample clinical studies.

关 键 词：心肌梗死 完全血运重建 罪犯血管血运重建 系统评价 主要不良心血管事件 心血管疾病 

分 类 号：R542.22[医药卫生—心血管疾病]