Department of Medicine, Montreal Heart Institute, Université de Montréal, Québec, Canada.
EuroIntervention. 2013 Feb 22;8(10):1207-16. doi: 10.4244/EIJV8I10A185.
To conduct a meta-analysis of studies comparing immediate versus delayed stenting in populations where primary percutaneous coronary intervention (PCI) or early invasive revascularisation was the initial mode of reperfusion.
We identified five non-randomised studies and one randomised trial for a total of 590 patients in studies comparing immediate to delayed stenting in populations where primary PCI or early invasive revascularisation was the initial mode of reperfusion. In non-randomised studies, delayed stenting was associated with a reduction of procedure-related angiographic events (OR=0.13, 95% credible interval [CrI]: 0.03- 0.36). No differences were observed in the rates of major bleeding (OR=0.81, 95% CrI: 0.01-13.42) and major adverse cardiac events (OR=0.40, 95% CrI: 0.09-1.91), between delayed and immediate stenting. In one randomised trial, delayed stenting was associated with a reduction in myocardial infarction during hospitalisation (39% vs. 60%; relative risk [RR]=0.55, 95% confidence interval [CI]: 0.39-0.80). None of the patients assigned to delayed stenting experienced a major adverse cardiac event in the interval between the initial angiogram and the stenting.
Delayed stent implantation is associated with better angiographic outcomes. Randomised trials are required to assess whether delayed stenting translates into better long-term cardiac outcomes.
对比较直接支架置入与延迟支架置入的研究进行荟萃分析，这些研究的人群中，初始再灌注方式为经皮冠状动脉介入治疗（PCI）或早期侵入性血运重建。
我们共纳入了 5 项非随机研究和 1 项随机试验，共纳入了 590 例在初始再灌注方式为经皮冠状动脉介入治疗或早期侵入性血运重建的人群中比较直接支架置入与延迟支架置入的研究。在非随机研究中，延迟支架置入与降低与操作相关的血管造影事件相关（OR=0.13，95%可信区间[CrI]：0.03-0.36）。在主要出血（OR=0.81，95%CrI：0.01-13.42）和主要不良心脏事件（OR=0.40，95%CrI：0.09-1.91）的发生率方面，延迟支架置入与直接支架置入之间无差异。在一项随机试验中，延迟支架置入与住院期间心肌梗死发生率降低相关（39%比 60%；相对风险[RR]=0.55，95%置信区间[CI]：0.39-0.80）。在初始血管造影和支架置入之间的间隔期间，无延迟支架置入组的患者发生主要不良心脏事件。
延迟支架置入与更好的血管造影结果相关。需要进行随机试验来评估延迟支架置入是否转化为更好的长期心脏结局。
