负荷他汀类药物对急性ST段抬高型心肌梗死患者介入治疗术后疗效的Meta分析

Effect of high-dose statins in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention:a meta-analysis and systematic review

目的评价负荷他汀类药物对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗术后的疗效。方法计算机检索Pub Med、EMBASE、Cochrane Library等数据库,收集数据库建库至2017年3月的随机对照试验研究。两位评价者独立评价纳入研究质量、提取资料并交叉核对。采用Rev Man 5.3软件进行Meta分析。结果共纳入11项RCT研究,合计1 419例患者。PCI术前负荷他汀类药物对心肌梗死溶栓治疗(thrombolysis in myocardial infarction,TIMI)后血流的改善显著高于对照组(RR=1.09,95%CI:1.05~1.13,P<0.01)。负荷组30 d主要心血管不良事件(major adverse cardiovascular events,MACEs)的发生率低于对照组(RR=0.50,95%CI:0.32~0.79,P<0.01)。亚组分析结果显示:PCI术前单次负荷他汀治疗后30 d MACEs的发生率(RR=0.47,95%CI:0.22~1.01,P=0.05)。短期负荷他汀治疗后30 d MACEs的发生率(RR=0.52,95%CI:0.30~0.91,P<0.05)。结论 STEMI患者负荷他汀治疗能改善PCI术后心肌血流灌注,能降低30 d MACEs的发生率。

Objective To determine the effect of high-dose statins in patients with ST-segment elevation myocardial infarction （STEMI） undergoing percutaneous coronary intervention （PCI）. Methods PubMed, EMBASE, Cochrane Library, CNKI and SinoMed were searched for randomized controlled trials （RCTs） concerning above subjects and treatments published up to March, 2017. Two reviewers independently evaluated the quality of the included studies. Meta-analysis was performed by RevMan 5.3 software. Results Eleven RCTs involving 1 419 patients were included. The results showed that high-dose statins significantly improved the final thrombolysis in myocardial infarction （TIMI） flow grade after PCI （RR=1.09, 95%CI=1.05～1.13, P〈0.01） and reduced the incidence of major adverse cardiovascular events （MACEs） at 30-day follow-up （RR=0.50, 95%CI=0.32～0.79, P〈0.01）. Subgroup analysis indicated that only shortterm highdose statin （RR=0.52, 95%CI=0.30～0.91, P〈0.05） but not single high-dose statin treatment （RR=0.47, 95%CI=0.22～1.01, P=0.05） showed priority in decreasing the occurrence of MACEs. Conclusion High-dose statins can significantly improve microvascular myocardial perfusion and decrease the incidence of 30-day MACEs in STEMI patients after PCI.