S-T段抬高型心肌梗死及合并心源性休克患者急诊PCI术中血运重建策略的荟萃分析

 目的 为S-T段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗方案提供循证医学证据。方法 计算机检索并筛查Medline、Pubmed、Web of Science、Clinicaltrials.gov、知网、万方和SinoMed数据库中2019年6月前发表的文献,利用Jadad评分评估文献质量。采用随机效应模型进行荟萃分析,并利用Egger回归分析评估发表偏倚。结果 共纳入13项研究,3617例患者,其中1817例接受了完全血运重建。对于S-T段抬高型心肌梗死患者,完全血运重建组主要心血管不良事件发生率(RR=0.562,95％CI:0.47~0.68,P<0.001)、全因死亡(RR=0.654,95％CI:0.53~0.82,P<0.001)和再次血运重建率(RR=0.495,95％CI:0.36~0.68,P<0.001)均显著降低,再发心肌梗死发生率差异无统计学意义。 对于合并心源性休克的急性心肌梗死的患者,完全血运重建降低了主要心血管不良事件发生率(RR=0.764,95％CI:0.60~0.98,P=0.034)。各项结果的发表偏倚不显著。结论 完全血运重建能够降低S-T段抬高型心肌梗死患者主要心血管不良事件发生率、全因死亡和再次血运重建率。对于合并心源性休克的急性心肌梗死患者,完全血运重建可以减少主要心血管不良事件发生率。

Meta-analysis of revascularization strategies for STEMI patients during primary PCI

Objective To provide evidence-based medical evidence for primary PCI in STEMI patients. Methods Papers published in the Medline, Pubmed, Web of Science, Clinicaltrials.gov, CNKI, Wanfang, and SinoMed before June 2019 were retrieved and screened out via computers while the Jadad score was used to assess the quality of the papers. Meta-analysis was performed with the random effects model, and publication bias was assessed with Egger regression analysis. Results A total of 3,617 patients from 13 studies were enrolled, 1,817 of whom underwent complete revascularization. For STEMI patients, the incidence of MACE (RR=0.562, 95% CI:0.47-0.68, P<0.001), all-cause death (RR=0.654, 95% CI:0.53-0.82, P<0.001) and revascularization rate (RR=0.495, 95% CI: 0.36-0.68, P<0.001) in the complete revascularization group were significantly reduced, but there was no significant difference in the incidence of recurrent myocardial infarction. For AMI patients with cardiogenic shock, complete revascularization reduced the incidence of MACE (RR=0.764, 95% CI: 0.60-0.98, P=0.034). The publication bias was not significant. Conclusions Complete revascularization can reduce the incidence of major cardiovascular adverse events, all-cause death and revascularization in patients with S-T segment elevation myocardial infarction. For acute myocardial infarction patients with cardiogenic shock, complete revascularization can reduce the incidence of major cardiovascular adverse events.