主动脉内球囊反搏对接受不同血管重建急性心肌梗死患者预后影响的荟萃分析

Efficacy of intra-aortic balloon counterpulsation in patients with acute myocardial infarctionaccording to the type of revascularization： a meta-analysis

目的探讨主动脉内球囊反搏（IABP）对接受不同血管重建治疗急性心肌梗死（AMI）患者预后的影响。方法联机检索Medline、Embase和Cochrane数据库，收集1970年1月至2015年5月期间发表的IABP治疗AMI的临床随机对照试验文献，按纳入与排除标准选择文献。对照组的治疗采用血管重建（溶栓、经皮冠状动脉介入治疗或冠状动脉旁路移植术），试验组在对照组基础上使用IABP。采用RevMan5．0软件对文献进行荟萃分析。结果（1）共纳入临床随机对照试验文献11篇，入选患者2225例，其中试验组1102例，对照组1123例。（2）试验组与对照组之间的住院或30d病死率差异无统计学意义（OR：0．84，95％cI0．65～1．09，P=0．20）。（3）在接受溶栓治疗的患者中，试验组与对照组之间的住院或30d病死率差异无统计学意义（OR=0．64，95％C10．25～1．61，P=0．34）；在接受经皮冠状动脉介入治疗的患者中，试验组与对照组之间的住院或30d病死率差异无统计学意义（OR=0．89，95％C10．68～1．18，P=0．42）；在接受冠状动脉旁路移植术的患者中，试验组与对照组之间的住院或30d病死率差异无统计学意义（OR=0．46，95％C10．13～1．63，P=0．23）。（4）在经皮冠状动脉介入治疗前使用IABP的患者中，试验组与对照组之间的住院或30d病死率差异无统计学意义（OR=0．47，95％C10．22～1．00，P=0．05）；在经皮冠状动脉介入治疗后使用IABP的患者中，试验组与对照组之间的住院或30d病死率差异也无统计学意义（OR=1．33，95％C10．63～2．79，P：0．45）。结论IABP不降低接受血管重建治疗AMI患者的住院或30d病死率。在经皮冠状动脉介入治疗前使用IABP可能会降低AMI患者的住院或30d病死率，但需要大样本临床随机对照试验的证实。

Objective To evaluate the effects of intra-aortic balloon counterpulsation （IABP） on mortality in patients with acute myocardial infarction according to the type of revascularization. Methods Recruited randomized controlled trials of IABP compared with no-IABP controls in acute myocardial infarction patients from January 1970 to May 2015 were searched from Medline, Embase and Cochrane Libra, according to inclusion criteria and exclusion criteria. These data were analyzed using the methods recommended by the Cochrane Collaboration＇s software RevMan 5.0. Revascularization included thrombolytic therapy, percutaneous coronary intervention （PCI）, or coronary artery bypass grafting. Results （ 1 ） Eleven randomized controlled trials were enrolled for analysis with 1 102 patients in IABP group, 1 123 in no-IABP control group. （2） Compared with no-IABP control group, IABP could not significantly decrease the in-hospital or 30 day mortality （ OR =0.84,95% CI O. 65 - 1.09,P =0. 20）. （3） Compared with no- IABP control group, IABP could not significantly decrease the in-hospital or 30 day mortality in thrombolytic patients（ OR =0. 64,95% CI O. 25 - 1.61 ,P = 0. 34）, in PCI patients （ OR = 0. 89,95% CI O. 68 - 1. 18, P = 0.42） , and in coronary artery bypass grafting patients （ OR = 0.46,95% CI O. 13 - 1.63, P = 0. 23 ）.（4） The difference reached borderline signiicance between no-IABP control group and IABP group in patients using IABP before PCI（ OR =0. 47,95% CI O. 22 - 1.00 ,P =0. 05）, but not in case of after PCI（ OR = 1.33, 95% C10. 63 - 2. 79,P = 0. 45 ）. Conclusions IABP does not decrease the in-hospital or 30 day mortality of acute myocardial infarction patients who received thrombolytic therapy, PCI, or coronary artery bypass grafting. But IABP might decreases the in-hospital or 30 day mortality in patients when used before PCI.