急性冠状动脉综合征患者经皮冠状动脉介入治疗期间病灶内注射与冠状动脉内注射糖蛋白IIb/IIIa抑制剂的比较：随机对照试验的荟萃分析

Intralesional versus intracoronary administration of glycoprotein IIb/IIIa inhibitors during percutaneous coronary intervention in patients with acute coronary syndromes: A meta-analysis of randomized controlled trials.

作者信息

Sun Binjie, Liu Zhen, Yin Hongshan, Wang Tao, Chen Tao, Yang Sen, Jiang Zhian

机构信息

Department of Cardiology, The Third Hospital of Hebei Medical University Department of Epidemiology and Health Statistics, Center for Disease Control and Prevention of Hebei Province, Shijiazhuang, P.R. China.

出版信息

Medicine (Baltimore). 2017 Oct;96(40):e8223. doi: 10.1097/MD.0000000000008223.

BACKGROUND

Glycoprotein IIb/IIIa inhibitors (GPIs) have been regarded as an adjuvant regimen to deal with no-reflow. However, whether intralesional (IL) administration of GPIs improves myocardial reperfusion without increasing bleeding in patients with acute coronary syndrome (ACS) compared with intracoronary (IC) administration has not been well addressed. Our meta-analysis aimed to evaluate the efficacy and safety of IL versus IC administration of GPIs for patients with ACS during percutaneous coronary intervention.

METHODS

We systematically searched Medline, Embase, the Cochrane Central Register of Controlled Trials, and Cambridge Scientific Abstracts from January 2007 to May 2017. Thrombolysis in Myocardial Infarction (TIMI) 3 flow, corrected TIMI frame count (CTFC), and complete ST-segment resolution (>70%) were selected as the primary outcomes. Major adverse cardiac events (MACEs) were the secondary outcome, and major bleeding complications were the safety outcome. Data analysis was conducted using the Review Manager 5.3 software.

RESULTS

Six randomized controlled trials were included in our meta-analysis. Compared with IC, IL obtained better results in terms of TIMI grade 3 flow [odds ratio (OR) 2.29; 95% confidence intervals (CIs) 1.31-4.01; P = .004], CTFC [weighted mean difference (WMD) -4.63; 95% CI -8.82 to -0.43; P = .03], and complete ST-segment resolution (OR 1.55; 95% CI 1.12-2.14; P = .008). There was a trend toward decreased MACE in the IL administration groups, which was not of statistical significance (OR 0.63; 95% CI 0.30-1.31; P = .22). No significant difference was found between the two groups in terms of in-hospital major bleeding events (OR 2.52; 95% CI .66 to 9.62; P = .18).

CONCLUSION

IL administration yielded favorable outcomes in terms of myocardial tissue reperfusion as evidenced by the improved TIMI flow grade, CTFC, complete ST-segment resolution, and decreased MACE without increasing in-hospital major bleeding events. The IL administration of GPIs can be recommended as the preferred regimen to guard against no-reflow.

背景

糖蛋白IIb/IIIa抑制剂（GPIs）一直被视为处理无复流的辅助治疗方案。然而，与冠状动脉内（IC）给药相比，急性冠状动脉综合征（ACS）患者病灶内（IL）注射GPIs能否在不增加出血风险的情况下改善心肌再灌注，这一问题尚未得到充分探讨。我们的荟萃分析旨在评估在经皮冠状动脉介入治疗期间，IL与IC注射GPIs治疗ACS患者的疗效和安全性。

方法

我们系统检索了2007年1月至2017年5月期间的Medline、Embase、Cochrane对照试验中央注册库和剑桥科学文摘数据库。心肌梗死溶栓（TIMI）3级血流、校正TIMI帧数（CTFC）和ST段完全回落（>70%）被选为主要观察指标。主要不良心脏事件（MACEs）为次要观察指标，主要出血并发症为安全性观察指标。使用Review Manager 5.3软件进行数据分析。

结果

我们的荟萃分析纳入了6项随机对照试验。与IC给药相比，IL给药在TIMI 3级血流方面取得了更好的结果[比值比（OR）2.29；95%置信区间（CIs）1.31 - 4.01；P = 0.004]，CTFC方面[加权平均差（WMD）-4.63；95% CI -8.82至-0.43；P = 0.03]，以及ST段完全回落方面（OR 1.55；95% CI 1.12 - 2.14；P = 0.008）。IL给药组的MACE有下降趋势，但无统计学意义（OR 0.63；95% CI 0.30 - 1.31；P = 0.22）。两组在院内主要出血事件方面未发现显著差异（OR 2.52；95% CI 0.66至9.62；P = 0.18）。