Manfrini Olivia, Ricci Beatrice, Dormi Ada, Puddu Paolo Emilio, Cenko Edina, Bugiardini Raffaele
Department of Experimental, Diagnostics and Specialty Medicine, University of Bologna, Via Giuseppe Massarenti 9, 40138 Bologna, Italy.
Department of Medical and Surgical Sciences, University of Bologna, Via S. Giacomo 12, 40126 Bologna, Italy.
Sci Rep. 2016 Jun 7;6:27345. doi: 10.1038/srep27345.
Randomized controlled trials (RCTs) were conflicting to support whether unstable angina versus non-ST-elevation myocardial infarction (UA/NSTEMI) patients best undergo early invasive or a conservative revascularization strategy. RCTs with cardiac biomarkers, in MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials from 1975-2013 were reviewed considering all cause mortality, recurrent non-fatal myocardial infarction (MI) and their combination. Follow-up lasted from 6-24 months and the use of routine invasive strategy up to its end was associated with a significantly lower composite of all-cause mortality and recurrent non-fatal MI (Relative Risk [RR] 0.79; 95% confidence interval [CI], 0.70-0.90) in UA/NSTEMI. In NSTEMI, by the invasive strategy, there was no benefit (RR 1.19; 95% CI, 1.03-1.38). In the shorter time period, from randomization to discharge, a routine invasive strategy was associated with significantly higher odds of the combined end-point among UA/NSTEMI (RR 1.29; 95% CI, 1.05-1.58) and NSTEMI (RR 1.82; 95% CI, 1.34-2.48) patients. Therefore, in trials recruiting a large number of UA patients, by routine invasive strategy the largest benefit was seen, whereas in NSTEMI patients death and non-fatal MI were not lowered. Routine invasive treatment in UA patients is accordingly supported by the present study.
随机对照试验（RCTs）在支持不稳定型心绞痛与非ST段抬高型心肌梗死（UA/NSTEMI）患者究竟是采用早期侵入性还是保守性血运重建策略方面存在矛盾。检索了1975年至2013年MEDLINE、EMBASE和Cochrane对照试验中心注册库中包含心脏生物标志物的随机对照试验，评估全因死亡率、复发性非致命性心肌梗死（MI）及其综合情况。随访持续6至24个月，在UA/NSTEMI中，直至随访结束采用常规侵入性策略与全因死亡率和复发性非致命性MI的综合情况显著降低相关（相对风险[RR]0.79；95%置信区间[CI]，0.70 - 0.90）。在非ST段抬高型心肌梗死（NSTEMI）中，采用侵入性策略并无益处（RR 1.19；95%CI，1.03 - 1.38）。在较短时间段内，即从随机分组至出院，常规侵入性策略与UA/NSTEMI（RR 1.29；95%CI，1.05 - 1.58）和NSTEMI（RR 1.82；95%CI，1.34 - 2.48）患者联合终点的较高几率相关。因此，在纳入大量UA患者的试验中，采用常规侵入性策略获益最大，而在NSTEMI患者中死亡和非致命性MI并未降低。本研究相应地支持对UA患者进行常规侵入性治疗。
