区域协同救治体系对急性ST段抬高型心肌梗死救治效率及预后影响的Meta分析

The effect of regional collaborative care system on the treatment time and prognosis of acute st elevation myocardial infarction patients:a meta-analysis

目的 通过Meta分析方法,探讨区域协同救治体系对急性ST段抬高型心肌梗死患者救治效率及疾病预后的影响。方法 计算机检索Web of science、PubMed、Embase、Ovid、Cochrane Library、CINAHL、中国生物医学文献数据库、中国知网、万方数据库及维普网等数据库中关于区域协同救治体系运行前后急性ST段抬高型心肌梗死患者救治效率及疾病预后的队列研究,检索时限为建库至2022年11月。由两名研究人员分别对检索结果进行文献筛选及数据提取、采用纽卡斯尔-渥太华量表进行文献质量评价。使用Revman 5.4及Stata16.0进行数据分析,评估研究的异质性并进行亚组分析。结果 本研究共纳入29篇文献,共包含研究对象51 953例,其中试验组26 110例,对照组25 843例。Meta分析结果显示,区域协同救治运行后ST段抬高型心肌梗死患者PCI医院入门至球囊扩张(D-to-B)时间较运行前缩短[MD=-42.14,95%CI:(-61.54,-22.74)](P<0.001),不同地区研究间异质性较大(I2=99%>50%);2012年前区域协同救治的运行与D-to-B时间无关[MD=50.67,95%CI:(-103.35,2.00)](P=0.060);区域协同救治运行后直接PCI患者比例得到提高[OR:1.78,95%CI:(1.23,2.57)](P=0.002)、整体死亡率下降[OR:0.77,95%CI:(0.71,0.82)](P<0.001);区域协同救治运行后ST段抬高型心肌梗死患者术后1个月[OR:0.40,95%CI:(0.25,0.64)]及6个月[OR:0.47,95%CI:(0.22,0.97)]主要不良心脏事件(MACE)发生率低于运行前(P<0.001;P=0.040),但随访12个月MACE发生率无明显差异[OR:0.61,95%CI:(0.32,1.16)](P=0.130)。结论 区域协同救治体系可缩短急性D-to-B时间并提高直接PCI患者比例,改善急性ST段抬高型心肌梗死患者短期预后,但对患者远期预后无明显影响。未来还需总结先进经验,促进各地区区域协同救治体系救护水平的均衡发展,加强社区居家心脏康复建设投入,降低冠心病患者病死率。

Objective evaluate the effect of regional coordination system on the treatment efficiency and prognosis of acute ST elevation myocardial infarction patients by Meta-analysis.Methods Web of science,PubMed,Embase,Ovid,Cochrane Library,CINAHL,Chinese biomedical literature database,CNKI,Wanfang database and VIP database were searched by search engine for cohort studies on the treatment efficiency and disease prognosis of acute ST elevation myocardial infarction patients before and after the operation of regional collaborative treatment system from database establishment to November 2022.Two researchers screened and extracted the search results,and evaluated the quality of the literature using the Newcastle-Ottawa scale.Data analysis were performed using Revman 5.4 and Stata16.0 to assess heterogeneity of studies and perform subgroup analyses.Results A total of 29 articles were included in this study,including 51953 subjects,including 26110 in the test group and 25843 in the control group.Meta-analysis showed that D-to-B time after regional collaborative care operation was significantly shorter than that before operation[MD=-42.14,95%CI:(-61.54,-22.74)](P<0.001),but there was greater heterogeneity between different regions(I2=99%>50%),and there was no significant difference(P=0.060)in the operation time of regional collaborative care before 2012[MD=-50.67,95%CI:(-103.35,2.00)];the proportion of patients with primary PCI increased after regional collaborative care operation[OR:1.78,95%CI:(1.23,2.57)](P=0.002),and the overall mortality decreased[OR:0.77,95%CI:(0.71,0.82)](P<0.001);The incidence of MACE in patients with ST-segment elevation myocardial infarction after regional collaborative care was lower(P<0.001;P=0.040)than that before operation at 1 month[OR:0.40,95%CI:(0.25,0.64)]and 6 months[OR:0.47,95%CI:(0.22,0.97)],but there was no significant different on the incidence of MACE at 12 months of follow-up[OR:0.61,95%CI:(0.32,1.16)](P=0.130).Conclusion Regional collaborative care system can improve the short-term prognosis of acute ST elevation myocardial infarction patients by shortening D-to-B time and increasing the proportion of primary PCI patients,but there are significant differences in various intervals.How to achieve regional collaborative care system to achieve the optimal effect in different regions needs to be further explored.