多支血管病变ST段抬高型心肌梗死患者经皮冠状动脉介入治疗中分期与一次性完全血运重建的比较：一项系统评价和荟萃分析

Staged versus One-Time Complete Revascularization with Percutaneous Coronary Intervention in STEMI Patients with Multivessel Disease: A Systematic Review and Meta-Analysis.

作者信息

Li Zhenwei, Zhou Yijiang, Xu Qingqing, Chen Xiaomin

机构信息

Department of Cardiology, The Affiliated Hospital Ningbo No.1 Hospital, Zhejiang University, Ningbo, PR China.

Department of Cardiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Ningbo, PR China.

出版信息

PLoS One. 2017 Jan 20;12(1):e0169406. doi: 10.1371/journal.pone.0169406. eCollection 2017.

INTRODUCTION

In patients with acute ST-elevation myocardial infarction (STEMI), the preferred intervention is percutaneous coronary intervention (PCI).Whether staged PCI (S-PCI) or one-time complete PCI (MV-PCI) is more beneficial and safer in terms of treating the non-culprit vessel during the primary PCI procedure is unclear. We performed a meta-analysis of all randomized and non-randomized controlled trials comparing S-PCI with MV-PCI in patients with acute STEMI and MVD.

METHODS

Studies of STEMI with multivessel disease receiving primary PCI were searched in PUBMED, EMBASE and The Cochrane Register of Controlled Trials from January 2004 to December 2014. The primary end points were long-term rates of major adverse cardiovascular events and their components-mortality, reinfarction, and target-vessel revascularization. Data were combined using a fixed-effects model.

RESULTS

Of 507 citations, 10 studies (4 randomized, 6 nonrandomized; 820 patients, 562 staged PCI and 347 one-time, complete multi-vessel PCI) were included. S-PCI compared to MV-PCI significantly reduced mortality both long-term (OR 0.44, 95% CI 0.29-0.66, P<0.0001, I2 = 0%) and short-term (OR 0.23, 95% CI 0.1-0.51, P = 0.0003, I2 = 0%). There was a trend toward reduced risk of MACE with s-PCI compared with MV-PCI (OR 0.83, 0.62-1.12, P = 0.22, I2 = 0%). No difference between S-PCI and MV-PCI was observed in reinfarction (OR 0.97, 0.61-1.55, P = 0.91, I2 = 0%), or target vessel revascularization (OR1.17, 95% CI 0.81-1.69, P = 0.40, I2 = 8%).

CONCLUSIONS

The staged strategy for non-culprit lesions improved short- and long-term survival and should remain the standard approach to primary PCI in patients with STEMI; one-time complete multivessel PCI may be associated with greater mortality risk. However, additional large, randomized trials are required to confirm the optimal timing of a staged procedure on the non-culprit vessel in STEMI.

引言

在急性ST段抬高型心肌梗死（STEMI）患者中，首选的干预措施是经皮冠状动脉介入治疗（PCI）。在初次PCI手术中，分期PCI（S-PCI）或一次性完成多支血管PCI（MV-PCI）在治疗非罪犯血管方面哪种更有益且更安全尚不清楚。我们对所有比较急性STEMI合并多支血管病变（MVD）患者的S-PCI与MV-PCI的随机和非随机对照试验进行了荟萃分析。

方法

在2004年1月至2014年12月期间，在PUBMED、EMBASE和Cochrane对照试验注册库中检索接受初次PCI的STEMI合并多支血管病变的研究。主要终点是主要不良心血管事件及其组成部分的长期发生率——死亡率、再梗死和靶血管血运重建。数据采用固定效应模型合并。

结果

在507篇文献中，纳入了10项研究（4项随机研究，6项非随机研究；820例患者，562例行分期PCI，347例行一次性完成多支血管PCI）。与MV-PCI相比，S-PCI在长期（OR 0.44，95%CI 0.29-0.66，P<0.0001，I² = 0%）和短期（OR 0.23，95%CI 0.1-0.51，P = 0.0003，I² = 0%）均显著降低了死亡率。与MV-PCI相比，S-PCI有降低主要不良心血管事件风险的趋势（OR 0.83，0.62-1.12，P = 0.22，I² = 0%）。在再梗死（OR 0.97，0.61-1.55，P = 0.91，I² = 0%）或靶血管血运重建（OR1.17，95%CI 0.81-1.69，P = 0.40，I² = 8%）方面，未观察到S-PCI与MV-PCI之间存在差异。