主动脉内球囊反搏在无心源性休克的急性心肌梗死患者中的应用。一项随机试验的荟萃分析。

Intra-aortic balloon counterpulsation in patients with acute myocardial infarction without cardiogenic shock. A meta-analysis of randomized trials.

机构信息

Deutsches Herzzentrum, Technische Universität, Munich, Germany.

出版信息

Am Heart J. 2012 Jul;164(1):58-65.e1. doi: 10.1016/j.ahj.2012.05.001.

DOI:10.1016/j.ahj.2012.05.001

PMID:22795283

Abstract

BACKGROUND

Conflicting data on intra-aortic balloon counterpulsation (IABC) as adjunctive therapy in high-risk acute myocardial infarction (AMI) without cardiogenic shock (CS) have been published. We performed a meta-analysis of randomized trials evaluating the benefits of IABC in patients with AMI without CS.

METHODS

We searched Medline, EMBASE, the Cochrane Central Register of Controlled Trials, and relevant Web sites for randomized trials comparing IABC versus no IABC in patients with AMI without CS. No language, publication date, or publication status restrictions were applied. Primary end point was all-cause death. Secondary end points were congestive heart failure (CHF), reinfarction, recurrent myocardial ischemia, cerebrovascular accidents (CVA), and bleeding (moderate to severe) according to per protocol definitions.

RESULTS

Six trials were included (1,054 patients, 49.1% IABC vs 50.9% no IABC). At follow-up, counterpulsation does not reduce all-cause death (4.4% vs 4.1%, odds ratio [OR] [95% CI] 1.11 [0.49-2.54], P = .80), CHF (17.1% vs 18%, OR 0.92 [0.43-1.96], P = .83), or reinfarction (5.3% vs 7.7%, OR 0.68 [0.23-1.76], P = .42). Intra-aortic balloon counterpulsation versus no IABC significantly reduces recurrent myocardial ischemia (3.6% vs 20.3%, OR 0.15 [0.08-0.28], P < .00001), but it increases the risk of CVA (2% vs 0.3%, OR 4.39 [1.11-17.36], P = .03) and bleeding (21.4% vs 16.1%, respectively, OR 1.46 [1.05-2.04], P = .02).

CONCLUSIONS

Counterpulsation does not reduce death, CHF, or reinfarction in patients with AMI without CS. The significant reduction of recurrent myocardial ischemia associated with IABC use is offset by a higher risk of CVAs and bleeding.

摘要

背景

在没有心源性休克（CS）的高危急性心肌梗死（AMI）中，主动脉内球囊反搏（IABC）作为辅助治疗的疗效数据存在冲突。我们对评估 AMI 合并无 CS 患者中 IABC 疗效的随机试验进行了荟萃分析。

方法

我们检索了 Medline、EMBASE、Cochrane 对照试验中心注册库和相关网站，以获取比较 AMI 合并无 CS 患者中 IABC 与非 IABC 的随机试验。未对语言、出版日期或出版状态进行限制。主要终点为全因死亡。次要终点为充血性心力衰竭（CHF）、再梗死、复发性心肌缺血、脑血管意外（CVA）和根据方案定义的中度至重度出血。

结果

纳入了 6 项试验（1054 例患者，49.1%接受 IABC 治疗，50.9%未接受 IABC 治疗）。在随访期间，反搏并不能降低全因死亡率（4.4%比 4.1%，比值比[OR] [95%置信区间] 1.11 [0.49-2.54]，P=.80）、CHF（17.1%比 18%，OR 0.92 [0.43-1.96]，P=.83）或再梗死（5.3%比 7.7%，OR 0.68 [0.23-1.76]，P=.42）。与不使用 IABC 相比，主动脉内球囊反搏可显著降低复发性心肌缺血（3.6%比 20.3%，OR 0.15 [0.08-0.28]，P <.00001），但增加了 CVA（2%比 0.3%，OR 4.39 [1.11-17.36]，P=.03）和出血（分别为 21.4%比 16.1%，OR 1.46 [1.05-2.04]，P=.02）的风险。