急性心肌梗死后室壁瘤形成影响因素的Meta分析

Meta-analysis of influence factors for ventricular aneurysm formation after acute myocardial infarction

目的探讨急性心肌梗死后室壁瘤形成的影响因素,为临床预防提供科学依据。方法检索中国知网、维普数据库、万方数据库、中国生物医学文献数据库、Web of Science、Embase、PubMed、Cochrane Library等,时限为建库至2020年6月,收集关于急性心肌梗死后室壁瘤形成影响因素的相关文献,应用RevMan5.3、Stata15.1软件对提取的数据进行Meta分析。结果最终纳入21篇文献,共7 430例患者。Meta分析结果显示,主要血管完全或次全闭塞(OR=3.50,95%CI=2.82~4.33)、前壁梗死(OR=5.08,95%CI=2.59~10.00)、发病至治疗时间≥12 h(OR=2.95,95%CI=2.29~3.80)、前降支病变(OR=6.46,95%CI=2.87~14.52)、年龄≥65岁(OR=1.84,95%CI=1.28~2.64)、LVEF<42%(OR=1.64,95%CI=1.15~2.33)、≥4个相邻导联ST段抬高(OR=3.67,95%CI=2.04~6.61)是急性心肌梗死后室壁瘤形成的危险因素;冠状动脉侧支循环(OR=0.43,95%CI=0.26~0.70)是急性心肌梗死后室壁瘤形成的保护性因素。结论主要血管完全或次全闭塞、前壁梗死、发病至治疗时间≥12 h、前降支病变、年龄≥65岁、LVEF<42%、≥4个相邻导联ST段抬高是急性心肌梗死后室壁瘤形成的危险因素;冠状动脉侧支循环是急性心肌梗死后室壁瘤形成的保护性因素。正确识别这些相关因素,可为医务人员制定预防策略提供依据。

Objective To investigate the influence factors for ventricular aneurysm formation after acute myocardial infarction,and to provide scientific basis for clinical prevention.Methods The CNKI,VIP database,Wanfang database,Chinese biomedical literature database,Web of Science,Embase,PubMed,Cochrane Library,etc.were searched,the time limit was from the establishment of the database to June 2020,and relevant literatures on influence factors for ventricular aneurysm formation after acute myocardial infarction were collected.Meta-analysis was performed on the extracted data by RevMan5.3 and Stata15.1 softwares.Results A total of 21 literatures were included finally,with a total of 7430 patients.Meta-analysis results showed that complete or subtotal occlusion of major blood vessels(OR=3.50,95%CI=2.82-4.33),anterior wall infarction(OR=5.08,95%CI=2.59-10.00),time from onset to treatment≥12 h(OR=2.95,95%CI=2.29-3.80),anterior descending branch disease(OR=6.46,95%CI=2.87-14.52),age≥65 years old(OR=1.84,95%CI=1.28-2.64),LVEF<42%(OR=1.64,95%CI=1.15-2.33),≥4 adjacent leads ST segment elevation(OR=3.67,95%CI=2.04-6.61)were the risk factors for ventricular aneurysm formation after acute myocardial infarction,and coronary collateral circulation(OR=0.43,95%CI=0.26-0.70)was a protective factor for ventricular aneurysm formation after acute myocardial infarction.Conclusion Complete or subtotal occlusion of major blood vessels,anterior wall infarction,time from onset to treatment≥12 h,anterior descending branch disease,age≥65 years old,LVEF<42%,≥4 adjacent leads ST segment elevation are the risk factors for ventricular aneurysm formation after acute myocardial infarction,while coronary collateral circulation is a protective factor for ventricular aneurysm formation after acute myocardial infarction.Correct identification of these related factors can provide a basis for medical staff to formulate prevention strategies.