Qiao Jianzhong, Pan Lingxin, Zhang Bin, Wang Jie, Zhao Yongyan, Yang Ru, Du Huiling, Jiang Jie, Jin Conghai, Xiong Enlai
Department of Cardiology, Tongling People's Hospital, Tongling, Anhui, China.
Department of Cardiology, Tongling People's Hospital, Tongling, Anhui, China
J Am Heart Assoc. 2017 Mar 8;6(3):e004838. doi: 10.1161/JAHA.116.004838.
A number of studies have evaluated the efficacy of deferred stenting vs immediate stenting in patients with ST-segment elevation myocardial infarction, but the findings were not consistent across these studies. This meta-analysis aims to assess optimal treatment strategies in patient with ST-segment elevation myocardial infarction.
We searched the PubMed, EMBASE, and the Cochrane Library for studies that assessed deferred vs immediate stenting in patients with ST-segment elevation myocardial infarction. Nine studies including 1456 patients in randomized controlled trials and 719 patients in observational studies were included in the meta-analysis. No significant differences were observed in the incidence of no- or slow-reflow between deferred stenting and immediate stenting in randomized controlled trials (odds ratio [OR] 0.51, 95%CI 0.17-1.53, =0.23, I=70%) but not in observational studies (OR 0.13, 95%CI 0.06-0.31, <0.0001, I=0%). Deferred stenting was associated with an increase in long-term left ventricular ejection fraction (weighted mean difference 1.90%, 95%CI 0.77-3.03, =0.001, I=0%). No significant differences were observed in the rates of major adverse cardiovascular events (OR 0.53, 95%CI 0.27-1.01, =0.06 [randomized OR 0.98, 95%CI 0.73-1.30, =0.87, I=0%; nonrandomized OR 0.30, 95%CI 0.15-0.58, =0.0004, I=0%]), major bleeding (OR=0.1.61, 95%CI 0.70-3.69, =0.26, I=0%), death (OR=0.78, 95%CI 0.53-1.15, =0.22, I=0%), MI (OR=0.97, 95%CI 0.34-2.78, =0.96, I=35%) and target vessel revascularization (OR 0.97, 95%CI 0.40-2.37, =0.95, I=24%), between deferred and immediate stenting.
Compared with immediate stenting, a deferred-stenting strategy did not reduce the occurrence of no- or slow-reflow, death, myocardial infarction, or repeat revascularization compared with immediate stenting in patients with ST-segment elevation myocardial infarction, but showed an improved left ventricular function in the long term.
多项研究评估了延迟支架置入术与直接支架置入术对ST段抬高型心肌梗死患者的疗效，但这些研究结果并不一致。本荟萃分析旨在评估ST段抬高型心肌梗死患者的最佳治疗策略。
我们检索了PubMed、EMBASE和Cochrane图书馆，以查找评估ST段抬高型心肌梗死患者延迟支架置入术与直接支架置入术的研究。荟萃分析纳入了9项研究，其中随机对照试验有1456例患者，观察性研究有719例患者。在随机对照试验中，延迟支架置入术与直接支架置入术之间的无复流或慢复流发生率无显著差异（优势比[OR]0.51，95%CI 0.17 - 1.53，P = 0.23，I² = 70%），但在观察性研究中存在显著差异（OR 0.13，95%CI 0.06 - 0.31，P < 0.0001，I² = 0%）。延迟支架置入术与长期左心室射血分数增加相关（加权平均差1.90%，95%CI 0.77 - 3.03，P = 0.001，I² = 0%）。延迟支架置入术与直接支架置入术在主要不良心血管事件发生率（OR 0.53，95%CI 0.27 - 1.01，P = 0.06[随机对照试验OR 0.98，95%CI 0.73 - 1.30，P = 0.87，I² = 0%；非随机对照试验OR 0.30，95%CI 0.15 - 0.58，P = 0.0004，I² = 0%]）、大出血（OR = 1.61，95%CI 0.70 - 3.69，P = 0.26，I² = 0%）、死亡（OR = 0.78，95%CI 0.53 - 1.15，P = 0.22，I² = 0%）、心肌梗死（OR = 0.97，95%CI 0.34 - 2.78，P = 0.96，I² = 35%）和靶血管血运重建（OR 0.97，95%CI 0.40 - 2.37，P = 0.95，I² = 24%）方面未观察到显著差异。
与直接支架置入术相比，延迟支架置入术在ST段抬高型心肌梗死患者中并未降低无复流或慢复流、死亡、心肌梗死或再次血运重建的发生率，但长期来看左心室功能有所改善。
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