中国STEMI患者早期应用替罗非班的有效性及安全性的Meta分析

Meta-analysis about the efficacy and safety of early administration of tirofiban in Chinese STEMI patients

目的评估中国ST段抬高心肌梗死(STEMI)患者在直接经皮介入治疗(PCI)术前(如急诊室、急救系统)早期启用替罗非班相比于常规术中启用替罗非班的有效性及安全性。方法检索截止至2016-09-30主要中英文数据库接受直接PCI的中国STEMI患者早期启用及常规术中启用替罗非班的有效性及安全性的随机对照研究,并进行荟萃分析。主要终点是PCI术前及术后的TIMI血流分级Ⅲ级的占比,次要终点为住院期间死亡、主要不良心血管事件(MACE)及30dMACE事件,安全性终点为住院期间出血及严重出血。结果最终纳入29篇文献,一共涉及3248例患者。两组的基线临床特征差异无统计学意义。与常规术中启用替罗非班相比,早期启用替罗非班可显著提高PCI术前及术后TIMI血流Ⅲ级的比例(术前RR2.36,95%CI1.96~2.84,P<0.00001;术后RR1.07,95%CI1.04~1.09,P<0.00001)。早期启用替罗非班虽然对住院期间死亡无明显影响(RR0.58,95%CI0.29~1.13,P=0.11),但有减少住院期间和30d内MACE的趋势(住院期间RR0.64,95%CI0.41~1.01,P=0.06;30d内RR0.51,95%CI0.38~0.68,P<0.00001)。两组在安全性方面差异并无统计学意义(出血RR1.10,95%CI0.90~1.36,P=0.35;大出血RR1.44,95%CI0.67~3.11,P=0.35)。结论对于接受急诊直接PCI的中国STEMI患者,早期启用替罗非班能改善术前及术后的血流灌注,未明显增加出血风险。

Objective To assess the efficacy and safety of early use of tirofiban in Chinese population of ST segment elevated myocardial infraction (STEMI)patients receiving primary percutaneous intervention (PC/).Methods We searched English and Chinese databases for articles published before September 30,2016.The Primary endpoints were the rate of TIMI blood flow grade Ⅲ before and after intervention.The secondary end point was death and major adverse cardiovascular events (MACE)during hospitalization and in 30 days.The safety end point was bleeding and severe bleeding events during hospitalization.Results 29 studies were included in this study.3248 subjects were involved.The two groups were similar in baseline characterize.Early use of tiroflban significantly increased the rate of TIMI blood flow grade Ⅲ both before and after operation (before operation:RR 2.36,95%CI 1.96 ~2.84,P <0.00001;after operation:RR 1.07,95%GI 1.04 -1.09,P < 0.0000.1).There was no significant difference in the mortality during hospitalization between the two groups.However,early initiation of tirofiban showed a trend of lower MACE during hospitalization and a significant reduction of MACE events within 30 days.There was no significant difference in safety events between the two groups (bleeding:RR 1.10,95%CI 0.90 -1.36,P =0.35;major bleeding:RR 1.44, 95%CI 0.67 ~3.11,P =0.35).Conclusion Early application of tirofiban can improve preoperative and postoperative blood perfusion in Chinese STEMI patients without increasing the risk of bleeding.