Gaffar Rouan, Habib Bettina, Filion Kristian B, Reynier Pauline, Eisenberg Mark J
Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.
Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
J Am Heart Assoc. 2017 Apr 10;6(4):e005381. doi: 10.1161/JAHA.116.005381.
Studies have suggested that complete revascularization is superior to culprit-only revascularization for the treatment of enzyme-positive acute coronary syndrome. However, the optimal timing of complete revascularization remains unclear. We conducted a systematic review and meta-analysis of randomized controlled trials comparing single-stage complete revascularization with multistage percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction or non-ST-segment elevation myocardial infarction with multivessel disease.
We systematically searched the Cochrane Central Register of Controlled Trials, Embase, PubMed, and MEDLINE for randomized controlled trials comparing single-stage complete revascularization with multistage revascularization in patients with enzyme-positive acute coronary syndrome. The primary outcome was the incidence of major adverse cardiovascular events at longest follow-up. Data were pooled using DerSimonian and Laird random-effects models. Four randomized controlled trials (n=838) were included in our meta-analysis. The risk of unplanned repeat revascularization at longest follow-up was significantly lower in patients randomized to single-stage complete revascularization (risk ratio, 0.68; 95% CI, 0.47-0.99). Results also suggest a trend towards lower risks of major adverse cardiovascular events for patients randomized to single-stage revascularization at 6 months (risk ratio, 0.67; 95% CI, 0.40-1.11) and at longest follow-up (risk ratio, 0.79; 95% CI, 0.52-1.20). Risks of mortality and recurrent myocardial infarction at longest follow-up were also lower with single-stage revascularization, but 95% CIs were wide and included unity.
Our results suggest that single-stage complete revascularization is safe. There also appears to be a trend towards lower long-term risks of mortality and major adverse cardiovascular events; however, additional randomized controlled trials are required to confirm the potential benefits of single-stage multivessel percutaneous coronary intervention.
研究表明，在酶阳性急性冠状动脉综合征的治疗中，完全血运重建优于仅对罪犯血管进行血运重建。然而，完全血运重建的最佳时机仍不明确。我们对随机对照试验进行了系统评价和荟萃分析，比较了ST段抬高型心肌梗死或非ST段抬高型心肌梗死合并多支血管病变患者的单阶段完全血运重建与多阶段经皮冠状动脉介入治疗。
我们系统检索了Cochrane对照试验中心注册库、Embase、PubMed和MEDLINE，以查找比较酶阳性急性冠状动脉综合征患者单阶段完全血运重建与多阶段血运重建的随机对照试验。主要结局是最长随访期时主要不良心血管事件的发生率。数据采用DerSimonian和Laird随机效应模型进行汇总。我们的荟萃分析纳入了四项随机对照试验（n=838）。随机接受单阶段完全血运重建的患者在最长随访期时计划外重复血运重建的风险显著更低（风险比，0.68；95%CI，0.47-0.99）。结果还表明，随机接受单阶段血运重建的患者在6个月时（风险比，0.67；95%CI，0.40-1.11）和最长随访期时（风险比，0.79；95%CI，0.52-1.20）发生主要不良心血管事件的风险有降低趋势。单阶段血运重建在最长随访期时的死亡和再发心肌梗死风险也更低，但95%CI较宽且包含1。
我们的结果表明单阶段完全血运重建是安全的。在死亡率和主要不良心血管事件的长期风险方面似乎也有降低趋势；然而，需要更多随机对照试验来证实单阶段多支血管经皮冠状动脉介入治疗的潜在益处。
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