维拉帕米对急性冠状动脉综合征患者经皮冠状动脉介入治疗相关无复流的短期影响：随机对照试验的系统评价和荟萃分析。
Short-term effect of verapamil on coronary no-reflow associated with percutaneous coronary intervention in patients with acute coronary syndrome: a systematic review and meta-analysis of randomized controlled trials.
机构信息
Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Cardiovascular Institute, Nanning, China.
出版信息
Clin Cardiol. 2013 Aug;36(8):E11-6. doi: 10.1002/clc.22143. Epub 2013 Jun 7.
BACKGROUND
To evaluate the clinical efficacy and safety of intracoronary verapamil injection in the prevention and treatment of coronary no-reflow after percutaneous coronary intervention (PCI).
HYPOTHESIS
Intracoronary verapamil injection may be beneficial in preventing no-reflow/slow-flow after PCI.
METHODS
We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials database. Randomized trials comparing the efficacy and safety of intracoronary verapamil infusion vs control in patients with acute coronary syndrome (ACS) were included. Meta-analysis was performed by RevMan 5.0 software (Cochrane Collaboration, Copenhagen, Denmark) .
RESULTS
Seven trials involving 539 patients were included in the analysis. Verapamil treatment was significantly more effective in decreasing the incidence of no-reflow (risk ratio [RR]: 0.33; 95% confidence interval [CI]: 0.23 to 0.50) as well as reducing the corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC) (weighted mean difference: -11.62; 95% CI: -16.04 to -7.21) and improving the TIMI myocardial perfusion grade (TMPG) (RR: 0.43; 95% CI: 0.29 to 0.64). Verapamil also reduced the 30-day wall motion index (WMI) compared to the control. Moreover, the procedure reduced the incidence of major adverse cardiac events (MACEs) in ACS patients during hospitalization (RR: 0.37; 95% CI: 0.17 to 0.80) and 2 months after PCI (RR: 0.56; 95% CI: 0.33 to 0.95). However, administration of verapamil did not provide an additional improvement of left ventricular ejection fraction regardless of the time that had passed post-PCI.
CONCLUSIONS
Intracoronary verapamil injection is beneficial in preventing no-reflow/slow-flow, reducing CTFC, improving TMPG, and lowering WMI. It is also likely to reduce the 2-month MACEs in ACS patients post-PCI.
背景
评估经皮冠状动脉介入治疗（PCI）后冠状动脉内维拉帕米注射预防和治疗无复流/慢血流的临床疗效和安全性。
假说
冠状动脉内维拉帕米注射可能有益于预防 PCI 后无复流/慢血流。
方法
我们检索了 PubMed、Embase 和 Cochrane 对照试验中心注册数据库。纳入比较急性冠脉综合征（ACS）患者冠状动脉内维拉帕米输注与对照组疗效和安全性的随机试验。采用 RevMan 5.0 软件（Cochrane 协作组，丹麦哥本哈根）进行荟萃分析。
结果
纳入的 7 项试验共 539 例患者。维拉帕米治疗组无复流发生率显著降低（风险比 [RR]：0.33；95%置信区间 [CI]：0.23 至 0.50），校正的心肌梗死溶栓治疗帧数（CTFC）减少（加权均数差：-11.62；95%CI：-16.04 至-7.21），TIMI 心肌灌注分级（TMPG）改善（RR：0.43；95%CI：0.29 至 0.64）。与对照组相比，维拉帕米还降低了 30 天的壁运动指数（WMI）。此外，该方案降低了 ACS 患者住院期间（RR：0.37；95%CI：0.17 至 0.80）和 PCI 后 2 个月（RR：0.56；95%CI：0.33 至 0.95）的主要不良心脏事件（MACE）发生率。然而，无论 PCI 后时间如何，维拉帕米的给药并不能提供左心室射血分数的额外改善。
结论
冠状动脉内维拉帕米注射有益于预防无复流/慢血流，减少 CTFC，改善 TMPG，降低 WMI。它还可能降低 PCI 后 ACS 患者 2 个月的 MACE 发生率。
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