初次经皮冠状动脉介入治疗期间的缺血后适应
Ischemic postconditioning during primary percutaneous coronary intervention.
作者信息
Mentias Amgad, Mahmoud Ahmed N, Elgendy Islam Y, Elgendy Akram Y, Barakat Amr F, Abuzaid A Sami, Saad Marwan, Kapadia Samir R
机构信息
Department of Medicine, Division of Cardiovascular Medicine, University of Iowa Carver College of Medicine, Iowa City, IA.
Department of Medicine, University of Florida, Gainesville, Florida.
出版信息
Catheter Cardiovasc Interv. 2017 Dec 1;90(7):1059-1067. doi: 10.1002/ccd.26965. Epub 2017 Mar 15.
BACKGROUND
Although some studies have shown potential benefit for ischemic postconditioning (IPoC) during primary percutaneous coronary intervention (PCI) in improving surrogate markers of reperfusion and infarction size, the benefit of this approach on clinical outcomes remains unknown.
METHODS AND RESULTS
Electronic databases were searched for randomized clinical trials that compared IPoC versus conventional treatment during primary PCI. Random effects DerSimonian-Laird risk ratios (RR) were calculated for different clinical and surrogate outcomes. The main outcome of this analysis was all-cause mortality. A total of 25 trials involving 3,619 patients were included in the analysis. At a mean follow up of 14 months (95% confidence interval (CI) 8.6-19.4 months), the incidence of all-cause mortality was 4.9% [95% CI 3.8-6.0%] in the IPoC group versus 3.8% [95% CI 1.9-5.7%] in the control group (RR 0.92, 95% CI 0.68-1.24, P = 0.74). The risk of reinfarction (2.7% [95% CI 1.1-4.3%] vs. 2.3% [0.6-4.0%]; RR 1.29, 95% CI 0.62-2.68, P = 0.72), heart failure (3.6% [95% CI 2.0-5.1%] vs. 5.7% [95% CI 3.3-8.2%]; RR 0.77, 95% CI 0.58-1.06, P = 0.24), target vessel revascularization (3.2% [95% CI 1.7-4.7%] vs. 2.4% [95% CI 1.4-3.3%]; RR 1.40, 95% CI 0.90-2.20, P = 0.20), and stent thrombosis (2.4% [95% CI 1.1-3.8%] vs. 1.8% [95% CI 0.5-3.2%]); RR 1.50, 95% CI 0.60-3.70, P = 0.40) was similar in both groups.
CONCLUSIONS
IPoC does not appear to reduce the risk of clinical adverse events in patients with ST-elevation myocardial infarction undergoing primary PCI. © 2017 Wiley Periodicals, Inc.
背景
尽管一些研究表明，在直接经皮冠状动脉介入治疗（PCI）期间，缺血后适应（IPoC）在改善再灌注替代指标和梗死面积方面具有潜在益处，但这种方法对临床结局的益处仍不明确。
方法与结果
检索电子数据库，查找比较直接PCI期间IPoC与传统治疗的随机临床试验。计算不同临床和替代结局的随机效应DerSimonian-Laird风险比（RR）。该分析的主要结局是全因死亡率。分析共纳入25项试验，涉及3619例患者。平均随访14个月（95%置信区间[CI] 8.6 - 19.4个月），IPoC组全因死亡率为4.9%[95% CI 3.8 - 6.0%]，而对照组为3.8%[95% CI 1.9 - 5.7%]（RR 0.92，95% CI 0.68 - 1.24，P = 0.74）。再梗死风险（2.7%[95% CI 1.1 - 4.3%]对2.3%[0.6 - 4.0%]；RR 1.29，95% CI 0.62 - 2.68，P = 0.72）、心力衰竭风险（3.6%[95% CI 2.0 - 5.1%]对5.7%[95% CI 3.3 - 8.2%]；RR 0.77，95% CI 0.58 - 1.06，P = 0.24）、靶血管血运重建风险（3.2%[95% CI 1.7 - 4.7%]对2.4%[95% CI 1.4 - 3.3%]；RR 1.4, 95% CI 0.90 - 2.20, P = 0.20）和支架血栓形成风险（2.4%[95% CI 1.1 - 3.8%]对1.8%[95% CI 0.5 - 3.2%]；RR 1.50，95% CI 0.60 - 3.70，P = 0.40）在两组中相似。
结论
对于接受直接PCI的ST段抬高型心肌梗死患者，IPoC似乎并未降低临床不良事件风险。© 2017威利期刊公司
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