主动脉内球囊反搏对急性心肌梗死经皮冠状动脉介入治疗后30 d内死亡率的影响

Intra-aortic balloon counterpulsation for patients with acute myocardial infarction and undergoing percutaneous coronary intervention： a meta-analysis

目的 探讨主动脉内球囊反搏（IABP）对接受经皮冠状动脉介入术（PCI）的急性心肌梗死（AMI）患者预后的影响.方法 联机检索MEDLINE、Embase、Web of Science等英文数据库,收集1970年1月至2015年5月有关IABP对接受PCI的AMI疗效的英文RCT文献,采用RevMan 5.0软件对数据进行Meta分析.结果 共纳入5篇RCT报告,入选患者1 450例,其中IABP组722例,非IABP（no-IABP）组728例.与非IABP（no-IABP）组相比,IABP组30 d病死率OR=0.92（95%CI：0.69-1.25,P=0.61）,差异无统计学意义.按照IABP时机亚组分析,PCI前亚组和PCI后亚组中,与no-IABP对照组相比,IABP组30 d病死率OR值分别为0.64（95%CI：0.23-1.78,P=0.39）和1.25（95%CI：0.42-3.77,P=0.69）,差异均无统计学意义.按AMI患者是否有心源性休克（CS）亚组分析,AMI伴CS亚组和不伴CS亚组中,与no-IABP组相比,IABP组30 d病死率OR值为0.96（95%CI：0.70-1.32,P=0.80）和0.68（95%CI：0.28-1.70,P=0.27）,差异均无统计学意义.结论 IABP不降低接受PCI治疗AMI患者的30 d病死率.

Objective To evaluate the effects of intra-aortic balloon counterpulsation （IABP） on mortality of patients with acute myocardial infarction （AMI） treated with percutaneous coronary intervention （PCI）.Methods Randomized controlled trials （RCTs） of IABP compared with non-IABP control in AMI patients, from January 1970 to May 2015, were searched from MEDLINE, Embase and Web of Science.The data were analyzed with software RevMan 5.0.Results Five RCTs involving 1 450 AMI patients, including 722 treated with IABP （IABP group） and 728 without IABP （non-IABP group）, were included for analysis.Compared with non-IABP group, IABP did not significantly decrease the hospital mortality or 30-day mortality （OR=0.92, 95%CI： 0.69-1.25,P=0.61）.According to the timing of IABP before or after PCI, it was further divided into IABP-before-PCI subgroup and IABP-after-PCI subgroup.Compared with non-IABP group, the 30-day mortality was not decreased in IABP-before-PCI subgroup or in IABP-after-PCI subgroup （OR=0.64, 95%CI： 0.23-1.78,P=0.39;OR=1.25, 95%CI： 0.42-3.77,P=0.69, respectively）.According to complicating with cardiogenic shock （CS） or not, patients were divided to AMI with CS subgroup and AMI with no-CS subgroup;the hospital or 30-day mortality were not significantly decreased in both subgroups （OR=0.96, 95%CI： 0.70-1.32,P=0.80;OR=0.68, 95%CI： 0.28-1.70,P=0.27, respectively）.Conclusion IABP does not decrease the 30-day mortality of AMI patients treated with PCI.