完全血运重建对急性ST段抬高型心肌梗死合并多支血管病变患者预后影响的Meta分析

Meta analysis of the effect of complete revascularization on the prognosis of patients with acute ST segment elevation myocardial infarction complicated with multi vessel disease

目的应用系统评价分析完全血运重建治疗方法对急性ST段抬高型心肌梗死(STEMI)合并多支血管病变患者的预后及影响。方法检索中国知网、万方数据、维普中文数据库、PubMed、Embase、Cochrane Library等数据库建立至2021年1月,纳入关于完全血运重建和仅罪犯血管介入治疗合并多支血管病变的急性ST段抬高型心肌梗死预后比较的随机对照试验的相关文献。依据选择标准筛选文献、提取资料后,使用Revman5.3软件进行Meta分析。结果最终纳入18篇随机对照试验,共11106例患者,其中完全血运重建组4680例,仅罪犯血管经皮冠状动脉介入治疗组6426例。Meta分析结果显示,完全血运重建组在主要心血管事件(MACE)(RR=0.60,95%CI 0.52-0.71,P<0.001)、全因死亡(RR=0.68,95%CI 0.58-0.81,P<0.001)、心因死亡(RR=0.62,95%CI 0.49-0.78,P<0.001)、再发心肌梗死(RR=0.78,95%CI 0.67-0.92,P=0.003)、再次血运重建(RR=0.48,95%CI 0.35-0.65,P<0.001)、再发心绞痛(RR=0.66,95%CI 0.47-0.93,P=0.02)发生率与仅罪犯血管PCI组比较均显著降低,差异有统计学意义;而2组术后心力衰竭(RR=0.64,95%CI 0.25-1.62,P=0.35)、冠状动脉旁路移植手术(CAGB)(RR=0.64,95%CI 0.58-1.66,P=0.94)、出血(RR=1.19,95%CI 0.88-1.46,P=0.33)、造影剂肾病(RR=1.59,95%CI 0.94-2.71,P=0.18)的发生率比较差异无统计学意义。结论完全血运重建治疗策略能有效减少合并多支血管病变的STEMI患者的MACE、全因死亡、心因死亡、再发心肌梗死、再次血运重建、心绞痛发生率,在一定程度上能够改善预后,且安全有效。

Objective The prognosis and influence of complete revascularization on patients with acute ST segment elevation myocardial infarction(STEMI)complicated with multi vessel disease were analyzed by systematic evaluation.Methods Search CNKI,Wanfang data,Vip Chinese database,PubMed,Embase,Cochrane Library and other databases until January 2021,and include relevant literature on randomized controlled trials for comparing the prognosis of complete revascularization and only criminal vascular interventional treatment of acute ST segment elevation myocardial infarction with multiple vascular diseases.After selecting literature and extracting data according to selection criteria,meta-analysis was conducted with Revman 5.3 software.Results Finally,18 randomized controlled trials were included,with a total of 11106 patients,including 4680 patients in the complete revascularization group and 6426 patients in the criminal vessel percutaneous coronary intervention group.Meta analysis showed that in the complete revascularization group,major cardiovascular events(MACE)(RR=0.60,95%CI 0.52-0.71,P<0.001),all-cause death(RR=0.68,95%CI 0.58-0.81,P<0.001),cardiac death(RR=0.62,95%CI 0.49-0.78,P<0.001),recurrent myocardial infarction(RR=0.78,95%CI 0.67-0.92,P=0.003),revascularization(RR=0.48,95%CI 0.35-0.65,P<0.001)The incidence of recurrent angina pectoris(RR=0.66,95%CI 0.47-0.93,P=0.02)was significantly lower than that in the criminal vessel PCI group,with a statistically significant difference;There was no significant difference between the two groups in the incidence of postoperative heart failure(RR=0.64,95%CI 0.25-1.62,P=0.35),coronary artery bypass grafting(CAGB)(RR=0.64,95%CI 0.58-1.66,P=0.94),bleeding(RR=1.19,95%CI 0.88-1.46,P=0.33),and contrast nephropathy(RR=1.59,95%CI 0.94-2.71,P=0.18).Conclusion Complete revascularization treatment strategy can effectively reduce the incidence of MACE,all-cause death,cardiac death,recurrent myocardial infarction,revascularization,angina pectoris in STEMI patients with multi vessel disease,and can improve the prognosis to a certain extent,and it is safe and effective.