PCI术后造影随访和常规随访对患者预后影响的Meta分析

Meta analysis of the impact of angiographic follow-up and routine follow-up after PCI on patient outcomes

目的系统评价经皮冠状动脉介入治疗(PCI)后造影随访和常规随访对患者预后的影响。方法计算机检索PubMed、Web of Science、Cochrane Library和EMbase数据库,同时手工检索纳入研究的参考文献,检索时间均为建库至2019年7月1日,搜集有关PCI术后造影随访(AF)和常规随访(CF)对患者预后影响的随机对照研究。由2位评价员按纳入与排除标准独立筛选文献、提取数据并按照Cochrane偏倚风险评估工具进行纳入研究的质量评价后,采用RevMan5.3软件进行Meta分析。结果共纳入随机对照试验6篇,患者7065例,其中AF组3492例,CF组4113例。Meta分析结果显示,与CF组相比,AF组患者总的再次血运重建率(RR=1.62,95%CI:1.32~2.00,P<0.00001)升高,靶血管血运重建(TVR)(RR=1.68,95%CI:1.18~2.38,P=0.004)和靶病变血运重建(TLR)(RR=1.64,95%CI:1.39~1.95,P<0.00001)发生率均明显升高;全因死亡率(RR=0.66,95%CI:0.50~0.87,P=0.004)下降;心肌梗死(MI)率(RR=0.80,95%CI:0.52~1.23,P=0.31)两组间无明显差异。结论冠状动脉(冠脉)造影作为PCI的随访手段之一,增加再次血运重建的机率,可能减少患者远期的全因死亡率和心肌梗死率。对高缺血风险患者的价值还需大样本完全随机方法的研究结果支持。

Objective To systematically evaluate the impact of angiographic follow-up and routine follow-up after percutaneous coronary intervention(PCI)on the prognosis of patients.Methods The PubMed,Web of Science,Cochrane Library,and EMbase databases were searched by computer,and the references included in the study were searched manually.The search time was from the establishment of the database to July 1,2019,and collected.randomized controlled trials of the effects of angiographic follow up(AF)and routine clinical follow-up(CF)on the prognosis of patients.Two reviewers independently screened the literature according to the inclusion and exclusion criteria,extracted the data,and evaluated the quality of the included studies according to the Cochrane bias risk assessment tool,and then used RevMan5.3 software for Meta analysis.Results A total of 6 randomized controlled trials were included,with a total of 7065 patients,including 3492 in the AF group and 4113 in the CF group.The results of Meta analysis showed that compared with the CF group,the total revascularization rate(RR=1.62,95%CI:1.32~2.00,P<0.00001)of AF group patients increased,and the incidence of target vessel revascularization(TVR)(RR=1.68,95%CI:1.18~2.38,P=0.004)and target lesion revascularization(TLR)(RR=1.64,95%CI:1.39~1.95,P<0.00001)were significantly increased;all-cause mortality(RR=0.66,95%CI:0.50~0.87,P=0.004)decreased.There was no significant difference in myocardial infarction(MI)rate between the two groups(RR=0.80,95%CI:0.52~1.23,P=0.31).Conclusion Coronary angiography,as one of the follow-up methods of percutaneous coronary intervention,increases the chance of revascularization and may reduce the long-term all-cause mortality and myocardial infarction rate.The value of angiographic follow up for high ischemia risk patients needs to be supported by the research results of a large sample of completely random methods.