亚低温在急性ST段抬高型心肌梗死治疗中作用的荟萃分析

Hypothermic therapy on patients with acute ST-segment elevation myocardial infarction:a meta-analysis

目的对亚低温治疗急性ST段抬高型心肌梗死(STEMI)的安全性和有效性做系统性回顾和荟萃分析。方法通过计算机检索和手工检索全面收集国内外关于亚低温治疗STEMI的随机对照研究(RCT)文献,按纳入与排除标准选择文献,评价纳入文献质量,提取资料,用RevMan 5.3软件对数据进行荟萃分析。评估安全性的指标为主要出血事件、室性心动过速/心室颤动、心动过缓。评估有效性的指标为主要不良心血管事件(MACE)、全因死亡率、梗死面积。结果按标准纳入11项RCT文献,共1180例诊断STEMI并接受直接经皮冠状动脉介入治疗的患者,其中597例被随机分配到低温治疗组,583例被分配到对照组。与对照组相比,亚低温治疗组的主要出血事件、室性心动过速/心室颤动、心动过缓及MACE、全因死亡率、梗死面积差异均无统计学意义(均为P>0.05)。此外,在亚组分析中,无论是在前壁心肌梗死还是非前壁心肌梗死患者中,亚低温治疗组和对照组的梗死面积差异均无统计学意义(均为P>0.05);无论患者的体温达标率≥80%还是<80%,亚低温治疗组和对照组的MACE、全因死亡率和梗死面积差异均无统计学意义(均为P>0.05)。结论此项荟萃分析证实,亚低温治疗在临床环境中是安全的,但并未改善STEMI患者的预后。

Objective To systematically review and meta-analyze the safety and efficacy of mild hypothermia in the treatment of acute ST-segment elevation myocardial infarction(STEMI).Methods Randomized controlled studies(RCTs)of the hypothermic therapy on patients with STEMI were comprehensively searched and manual retrieved.Articles were screened according to the presupposed inclusion and exclusion criteria.Quality assessment,data extraction was processed.Meta-analysis was done by RevMan 5.3.The safety endpoints included major bleeding,ventricular tachycardia/fibrillation,and bradycardia.The efficacy endpoints included major cardiovascular adverse events(MACE),all-cause mortality,and infarct size.Results A total of 1180 STEMI patients receiving primary percutaneous coronary intervention(PPCI)in 11 trials were enrolled and followed by quantitative synthesis.597 patients were randomly assigned to the hypothermic group while 583 patients were divided to the control group.Compared with the control group,no statistical significant differences appeared in major bleeding,ventricular tachycardia/ventricular fibrillation,bradycardia,MACE,all-cause mortality,or infarct size in hypothermic group(all P>0.05).Moreover,in the subgroup analysis,no significant difference was shown in infarct size between the two groups in either anterior wall group or non-anterior wall group(all P>0.05).In the temperature reaching rate≥80%subgroup or<80%subgroup,no statistical difference existed in MACE,all-cause mortality and infarct size between the two groups(all P>0.05).Conclusions This meta-analysis confirms that hypothermic therapy is safe in a clinical setting,but may be not helpful to improve the prognosis in STEMI patients.