Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China.
Ann Med. 2010 Apr;42(3):171-7. doi: 10.3109/07853890903463976.
Periprocedural myocardial injury remains the most common complication associated with percutaneous coronary intervention (PCI). Previous studies have demonstrated that even a small elevation of cardiac enzymes is associated with higher risk of mortality during follow-up.
We performed a meta-analysis based on all currently available randomized controlled trials (RCT) to evaluate the beneficial effects of hydroxymethylglutaryl-CoA reductase inhibitors (statins) given before PCI on preventing periprocedural myocardial infarction (MI).
The published literature was scanned by formal searches of electronic databases (PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials) and conference proceedings up through August 2009. RCTs were eligible for inclusion if they compared preprocedural statins versus placebo treatment in patients not taking statins previously but scheduled for PCI and had the data of periprocedural MI reported by the trial investigators.
Prespecified criteria were met by 6 RCTs involving 2,088 patients. During the periprocedural period, 81 of 1,051 patients (7.7%) in the statins pretreatment group developed periprocedural MI, significantly less than 147 of 1,037 (14.2%) patients assigned to the control group (OR 0.51, 95% CI 0.38-0.67; P< 0.001). During 1-month follow-up, only 4 deaths, 7 non-periprocedural Q-wave MIs, and 4 revascularizations occurred in all 2,088 enrolled patients. The composite of death, MI, or target vessel revascularization at 1 month, essentially driven by periprocedural MI, was reported in 8.0% in the statins pretreatment group and 15.3% in the control group (OR 0.48, 95% CI 0.36-0.64; P< 0.001).
This meta-analysis supports the effectiveness of statins pretreatment on reducing the rate of periprocedural MI in patients undergoing PCI.
经皮冠状动脉介入治疗（PCI）过程中，心肌损伤仍然是最常见的并发症。既往研究表明，即使心脏酶轻度升高，患者在随访期间的死亡率也会升高。
我们进行了一项基于所有现有随机对照试验（RCT）的荟萃分析，旨在评估 PCI 术前应用羟甲基戊二酰辅酶 A 还原酶抑制剂（他汀类药物）对预防围手术期心肌梗死（MI）的有益作用。
通过正式检索电子数据库（PubMed、EMBASE 和 Cochrane 对照试验中心注册库）和会议记录，对已发表的文献进行了扫描，检索时间截至 2009 年 8 月。如果 RCT 比较了 PCI 术前他汀类药物预处理与未服用他汀类药物但计划行 PCI 的患者的安慰剂治疗，且试验研究者报告了围手术期 MI 数据，则该 RCT 符合纳入标准。
6 项 RCT 符合预先设定的标准，共纳入 2088 例患者。在围手术期内，他汀预处理组 1051 例患者中有 81 例（7.7%）发生围手术期 MI，显著少于对照组 1037 例患者中的 147 例（14.2%）（OR 0.51，95% CI 0.38-0.67；P<0.001）。在 1 个月随访期间，所有 2088 例纳入患者中仅发生 4 例死亡、7 例非围手术期 Q 波 MI 和 4 例血运重建。1 个月时的死亡、MI 或靶血管血运重建的复合终点，主要由围手术期 MI 驱动，在他汀预处理组发生率为 8.0%，对照组为 15.3%（OR 0.48，95% CI 0.36-0.64；P<0.001）。
本荟萃分析支持 PCI 术前应用他汀类药物预处理可降低患者围手术期 MI 的发生率。
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