早期应用替罗非班对急性ST段抬高型心肌梗死患者PCI术后冠脉血流及并发症影响的Meta-分析

目的 系统评价早期应用替罗非班对急性ST段抬高型心肌梗死（STEMI）经皮冠状动脉介入（PCI）术后冠脉血流及并发症影响。方法 检索PubMed、Embase、Cochrane图书馆、中国学术期刊全文数据库（CNKI）、中国生物医学文献数据库（CBM）和维普中文期刊全文数据库（VIP）和万方数据库关于STEMI患者急诊行PCI并早期应用替罗非班的临床对照研究（RCT），检索年限均为建库起至2020年4月30日。试验组为PCI术前开始应用替罗非班，对照组为PCI术中或术后应用替罗非班，数据提取和质量评价，应用RevMan 5.3软件进行Meta-分析。结果 共纳入15项RCT，共计2 214例患者。Meta-分析结果显示，术前应用替罗非班组较术中或术后用药组，PCI术后TIMI血流分级为3级（RR=1.10，95%CI=1.06~1.15，P<0.01）和（RR=1.10，95%CI=1.03~1.17，P<0.01）、ST段下落幅度（SMD=0.44，95%CI=0.17~0.70，P=0.001）和（SMD=1.85，95%CI=1.53~2.17，P<0.01）、ST段回落率（RR=1.51，95%CI=1.20~1.89，P<0.01）和（RR=1.20，95%CI=1.05~1.39，P=0.01）均显著优于术中或术后用药；术前应用组提高左心室射血分数（LVEF%）（SMD=0.46，95%CI=0.13~0.79，P=0.007）和降低主要心血管不良事件（MACE）发生率（RR=0.53，95%CI=0.39~0.73，P<0.01）均优于术中用药组。术前应用组与术后应用组的LVEF%和MACE发生率比较均无显著性差异。术前应用组出血及并发症发生率与术中及术后应用组比较均无显著性差异。结论 与PCI术中及术后应用替罗非班相比，术前应用更能显著改善STEMI患者微循环障碍、增加心肌组织有效的再灌注、减少心肌梗死范围。

Effects of early using titrofiban on blood flow and complications in patients with acute ST-segment elevation myocardial infarction after percutaneous coronary intervention: a Meta-analysis

Objective To investigate the effect of early using titrofiban on blood flow and complications in patients with Acute STsegment elevation myocardial infarction (STEMI) after Percutaneous coronary intervention (PCI). Methods Randomized controlled clinical trials (RCTs) of early using titrofiban in STEMI patients with emergency PCI from database establishment to 30th April of 2020 were retrieved from PubMed, Embase, Cochrane library, CNKI, CBM, VIP and Wanfang database. The test group was given titrofiban before PCI, and the control group was given titrofiban during or after PCI. Meta-analysis were performed with RevMan 5.3 software. Results A total of 15 RCTs studies were finally included and involving 2 214 patients. Meta-analysis showed that, compared with the intra-operative application groups and post-operative application groups, the pre-operative application groups significantly improved the thrombolysis in myocardial infarction (TIMI) classification to 3 after PCI (RR=1.10, 95%CI=1.06 to 1.15, P<0.01) and (RR=1.10, 95%CI=1.03 to 1.17, P<0.01), significantly increased the drop amplitude of ST-segment (SMD=0.44, 95%CI=0.17 to 0.70, P=0.001) and (SMD=1.85, 95%CI=1.53 to 2.17, P<0.01), significantly increased the drop rate of ST-segment (RR=1.51, 95%CI=1.20 to 1.89, P<0.01) and (RR=1.20, 95%CI=1.05 to 1.39, P=0.01); compared with the intraoperative application groups, the pre-operative application groups significantly increased level of the left ventricular ejection fraction (LVEF%) (SMD=0.46, 95%CI=0.13 to 0.79, P=0.007) and decreased the incidence of major adverse cardiovascular events (MACE) (RR=0.53, 95%CI=0.39 to 0.73, P<0.01), but there were no significant difference in LVEF% and MACE between preoperative application groups and post-operative application groups. There were no significant difference in the incidence of bleeding and complications between the pre-operative application group and intra-operative application group and post-operative application group. Conclusion Compared with tirofiban using during and after PCI, using before PCI can significantly improve microcirculation disturbance,increase myocardial tissue effective reperfusion,and reduce myocardial infarct size in STEMI patients.