75岁以上老年非ST段抬高型急性冠脉综合征患者早期侵入性与早期保守治疗效果评价的meta分析  

A meta-analysis of the evaluation of early invasive and early conservative treatment effects in patients over 75 years of age with non-ST-elevation acute coronary syndrome

作　　者：张翔宇 耿巍[2] 李梦毓 闫少华 ZHANG Xiangyu;GENG Wei;LI Mengyu;YAN Shaohua(Graduate School of Hebei Medical University,Shijiazhuang,050000,China;Department of Cardiology,Baoding First Central Hospital)

机构地区：[1]河北医科大学研究生院,石家庄050000 [2]保定市第一中心医院心内科

出　　处：《临床心血管病杂志》2023年第10期788-793,共6页Journal of Clinical Cardiology

摘　　要：目的:评价75岁以上老年非ST段抬高型急性冠状动脉综合征(NSTE-ACS)患者早期侵入性与早期保守治疗效果。方法:检索Embase、Medline、Cochrane Library、PubMed、VIP、万方、CNKI等数据库,检索自建库至2023年4月12日的所有随机对照研究。结果:共纳入7篇研究。保守组与侵入组非致死性心肌梗死(OR=0.50,95%CI 0.37~0.67,P<0.00001)、血运重建(OR=0.27,95%CI 0.15~0.48,P<0.00001)及出血发生率(OR=1.88,95%CI 1.23~2.88,P=0.004)差异有统计学意义,全因死亡或非致死性心肌梗死复合终点(OR=0.78,95%CI 0.55~1.11,P=0.16)、全因死亡(OR=0.60,95%CI 0.32~1.12,P=0.11)、心血管死亡(OR=0.97,95%CI 0.47~1.99,P=0.93)、再入院率(OR=0.86,95%CI 0.55~1.33,P=0.49)差异无统计学意义。结论:在75岁以上的NSTE-ACS患者中,与保守组相比,侵入组显著降低了非致死性心肌梗死和血运重建的发生率,但显著增加了出血的风险。Objective To assess the effects of early invasive versus early conservative treatment in elderly patients over 75 years of age with non-ST-elevation acute coronary syndrome(NSTE-ACS).Methods Embase,Medline,Cochrane Library,PubMed,VIP,Wanfang,CNKI and other databases were searched,and all randomized controlled studies were searched from the establishment of the library to April 12,2023.Results A total of seven studies were included.There were significant differences in non-fatal myocardial infarction[OR=0.50,95%CI(0.37,0.67),P<0.00001],revascularization[OR=0.27,95%CI(0.15,0.48),P<0.00001]and bleeding incidence[OR=1.88,95%CI(1.23,2.88),P=0.004]between the invasion group and conservative group.In the composite endpoint of all-cause death or nonfatal myocardial infarction[OR=0.78,95%CI(0.55,1.11),P=0.16],all-cause mortality[OR=0.60,95%CI(0.32,1.12),P=0.11],cardiovascular death[OR=0.97,95%CI(0.47,1.99),P=0.93],readmission rate[OR=0.86,95%CI(0.55,1.33),P=0.49],the differences were not statistically significant.Conclusion In patients older than 75 years of NSTE-ACS,the incidence of nonfatal myocardial infarction and revascularization were significantly reduced in the invasive group,but the risk of bleeding significantly increased in the conservative group.

关 键 词：非ST段抬高型急性冠状动脉综合征 早期侵入治疗 药物保守治疗 META分析 

分 类 号：R541.4[医药卫生—心血管疾病]