完全血运重建术对存在多支血管病变的急性冠状动脉综合征患者围手术期安全性的荟萃分析

Meta-analysis of safety of complete revacularization in patients with acute coronary syndrome and multivessel disease

目的系统评价完全血运重建和部分血运重建对合并多支血管病变(MVD)的急性冠状动脉综合征(ACS)患者围手术期的安全性。方法检索英文数据库:Pubmed、Embase、Cochrane Collaboration和中文数据库:中国期刊全文数据库、万方数据库、维普数据库,查阅目前已知的不同血运重建方式治疗合并MVD的ACS患者的随机对照试验,筛查并纳入符合要求的高质量文献,应用RevMan5.3软件系统评价应用不同血运重建方式[多支血管血运重建(MV-PCI)和罪犯血管血运重建(CV-PCI)]治疗合并MVD的ACS患者的围手术期安全性,如平均住院日、梗死血管开通时间、造影剂用量、平均造影时间、血小板糖蛋白IIb/IIIa受体拮抗剂使用率、平均支架数、主动脉内球囊使用率、造影剂肾病发生率、出血事件的发生率等。结果共纳入18篇文献,119674例合并MVD的ACS患者。Meta分析结果显示:与仅处理罪犯血管的部分血运重建CV-PCI治疗相比,MV-PCI术可降低围手术期患者平均住院天数(MD=-4.27,95%CI-5.1^-3.44,P<0.00001),增加患者的支架使用数(MD=0.98,95%CI 0.88~1.09,P<0.00001)、造影剂使用量(MD=72.99,95%CI 33.24~112.73,P=0.0003)以及造影时间(MD=7.27,95%CI 2.2~12.35,P=0.005),但对患者的血管开通时间(MD=-0.64,95%CI-1.69^-0.41,P=0.24)和造影剂肾病发生率(RR=0.99,95%CI 0.51~1.92,P=0.98)、围手术期出血事件(RR=1.11,95%CI 0.84~1.46,P=0.48)和主动脉内球囊使用(RR=1.02,95%CI 0.83~1.24,P=0.88)并无影响。结论完全血运重建术可以降低多支血管病变ACS患者平均住院日,虽然增加患者经皮冠状动脉介入治疗术中造影剂用量、造影时间和平均支架数,但并不增加造影剂肾病的发病率、围手术期出血事件及心源性休克的发生率。

Objective To evaluate the perioperative safety of complete revascularization(MV-PCI)and partial revascularization(CV-PCI)in patients with acute coronary syndrome and multivessel disease.Methods Randomized controlled trials of different revascularization methods to prevent acute coronary syndrome were searched in databases including Pubmed,Embase,Cochrane Collaboration,CNKI,Wanfang Data,and VIP database.High-quality articles that met the requirements and the relevant data from the articles obtained were then screened and analyzed.RevMan5.3 software was used to evaluate the efficacy of different revascularization methods for the treatment of coronary multivessel disease with regard to average hospitalization days,time to opening of infarct-related vessel,contrast agent dosage,average contrast time,platelet glycoprotein IIb/IIIa receptor antagonist use,mean stent number,and intra-aortic balloon pump use.Results A total of 18 articles were included,involving 119674 patients with MV-ACS.Meta-analysis showed that compared with CV-PCI,MV-PCI significantly reduced perioperative mean hospital stay(MD=-4.27,95%CI:-5.1^-3.44,P<0.00001),and increased the number of stents used by patients(MD=0.98,95%CI:0.88~1.09,P<0.00001),contrast agent usage(MD=72.99,95%CI:33.24~112.73,P=0.0003),and contrast time(MD=7.27,95%CI:2.2~12.35,P=0.005),but vascular access time(MD=-0.64,95%CI:-1.69^-0.41,P=0.24),the incidence of radiographic contrast nephropathy(relative risk[RR]=0.99,95%CI:0.51~1.92,P=0.98),perioperative bleeding events(RR=1.11,95%CI:0.84~1.46,P=0.48),and intra-aortic balloon pump use rate(RR=1.02,95%CI:0.83~1.24,P=0.88)had no significant change.Conclusion MV-PCI can reduce perioperative vascular access time and mean hospitalization days in patients with MV-ACS,although the amount of contrast agent,contrast time,and average number of stents are increased,while the incidence of radiographic contrast nephropathy,perioperative bleeding events,and cardiogenic shock does not increase.