De Luca Giuseppe, Suryapranata Harry, Stone Gregg W, Antoniucci David, Neumann Franz-Joseph, Chiariello Massimo
Division of Cardiology, Ospedale Maggiore della Carita, Universite del Piemonte Orientale, Novara, Italy.
Am Heart J. 2007 Mar;153(3):343-53. doi: 10.1016/j.ahj.2006.11.020.
The benefits of adjunctive mechanical devices to prevent distal embolization in patients with acute myocardial infarction (AMI) are still a matter of debate. The aim of this meta-analysis was to combine data from all randomized trials conducted with adjunctive mechanical devices to prevent distal embolization in AMI.
The literature was scanned by formal searches of electronic databases (MEDLINE and Central) from January 1990 to October 2006, scientific session abstracts (from January 1990 to October 2006), and oral presentation and/or expert slide presentations (from January 2002 to October 2006) (on the Transcatheter Cardiovascular Therapeutics, American Heart Association, European Society of Cardiology, American College of Cardiology, and European Percutaneous Revascularization Web sites). We examined all randomized trials on adjunctive mechanical devices to prevent distal embolization in AMI. The following key words were used: randomized trial, myocardial infarction, reperfusion, primary angioplasty, rescue angioplasty, thrombectomy, thrombus aspiration, proximal or distal protection device, X-sizer, Diver, Export Catheter, Angiojet, Rescue catheter, Pronto catheter, PercuSurge, GuardWire, FilterWire, and SpideRX. Disagreements were resolved by consensus.
A total of 21 trials with 3721 patients were included (1877 patients [50.4%] in the adjunctive mechanical device group and 1844 [49.6%] in the control group); 1502 patients (40.3%) were randomized in trials with distal protection devices, and 2219 patients (59.7%) were randomized in trials with thrombectomy devices. Adjunctive mechanical devices were associated with a higher rate of postprocedural TIMI 3 flow (89.4% vs 87.1%, P = .03), a significantly higher rate of postprocedural myocardial blush grade 3 (48.8% vs 36.5%, P < .0001), and less distal embolization (6.0% vs 9.3%, P = .008), without any benefit in terms of 30-day mortality (2.5% vs 2.6%, P = .88). No difference was observed in terms of coronary perforations (0.27% vs 0.07%, P = .24).
This meta-analysis demonstrates that, among patients with AMI treated with percutaneous coronary intervention, the use of adjunctive mechanical devices to prevent distal embolization is associated with better myocardial perfusion and less distal embolization, but without an apparent improvement in survival.
辅助机械装置在急性心肌梗死（AMI）患者中预防远端栓塞的益处仍存在争议。本荟萃分析的目的是汇总所有使用辅助机械装置预防AMI远端栓塞的随机试验数据。
通过正式检索电子数据库（MEDLINE和CENTRAL，检索时间为1990年1月至2006年10月）、科学会议摘要（1990年1月至2006年10月）以及口头报告和/或专家幻灯片报告（2002年1月至2006年10月）（检索导管心血管治疗、美国心脏协会、欧洲心脏病学会、美国心脏病学会和欧洲经皮血管重建网站）来筛选文献。我们审查了所有关于使用辅助机械装置预防AMI远端栓塞的随机试验。使用了以下关键词：随机试验、心肌梗死、再灌注、直接经皮冠状动脉腔内血管成形术、补救性血管成形术、血栓切除术、血栓抽吸、近端或远端保护装置、X-sizer、Diver、Export导管、Angiojet、Rescue导管、Pronto导管、PercuSurge、GuardWire、FilterWire和SpideRX。分歧通过协商解决。
共纳入21项试验，3721例患者（辅助机械装置组1877例患者[50.4%]，对照组1844例患者[49.6%]）；1502例患者（40.3%）在使用远端保护装置的试验中随机分组，2219例患者（59.7%）在使用血栓切除术装置的试验中随机分组。辅助机械装置与术后TIMI 3级血流率较高（89.4%对87.1%，P = 0.03）、术后心肌显影3级率显著较高（48.8%对36.5%，P < 0.0001）以及远端栓塞较少（6.0%对9.3%，P = 0.008）相关，但在30天死亡率方面无任何益处（2.5%对2.6%，P = 0.88）。在冠状动脉穿孔方面未观察到差异（0.27%对0.07%，P = 0.24）。
本荟萃分析表明，在接受经皮冠状动脉介入治疗的AMI患者中，使用辅助机械装置预防远端栓塞与更好的心肌灌注和更少的远端栓塞相关，但生存率无明显改善。
