Lu Changqing, Jia Helei, Wang Zhentao
Department of Emergency, Henan Province Hospital of Traditional Chinese Medicine, Zhengzhou, Henan Province 450002, China.
Department of Cardiovascular Disease, Henan Province Hospital of Traditional Chinese Medicine, Zhengzhou, Henan Province 450002, China.
Oncotarget. 2017 Jul 31;8(41):70356-70365. doi: 10.18632/oncotarget.19701. eCollection 2017 Sep 19.
We systematically searched in PubMed, Web of Science, Embase and China National Knowledge Infrastructure from the inception to March 31, 2017, identified relevant trials about efficacy of high-does Atorvastatin for patients with percutaneous coronary intervention. Twelve studies with the number of 2801 patients were included in the meta-analysis. Compared with control group, high-does Atorvastatin significantly reduced the risk of myocardial infarction in patients with percutaneous coronary intervention (Relative risk =0.62, 95% confidence interval: 0.49-0.78), with low level of heterogeneity (I=22.6%, P=0.228). Nine studies with 2248 patients reported the adverse cardiovascular events. A fixed-effect model was applied. Compared with control group, patients with high-does Atorvastatin taken, the risk of adverse cardiovascular events was degraded by 65% (Relative risk, RR=0.65, 95% confidence interval (CI): 0.50-0.84), which was confirmed by trial sequential analysis as the cumulative Z curve entered the futility area. The subgroup analyses found that decreased risks of myocardial infarction among trails (RR=0.64, 95%CI: 0.50-0.83, RR=0.55, 95%CI: 0.34-0.88). Egger and Begg's test found no publication bias (t=-1.670, =0.129; Z=1.560, =0.119). The use of high-dose Atorvastatin could reduce the risk of myocardial infraction and cardiovascular adverse events in patients with percutaneous coronary intervention. High-dose Atorvastatin was recommended as an adjunct to aid percutaneous coronary intervention.
我们从数据库建库至2017年3月31日,系统检索了PubMed、Web of Science、Embase和中国知网,以确定有关高剂量阿托伐他汀对经皮冠状动脉介入治疗患者疗效的相关试验。12项研究共纳入2801例患者,进行荟萃分析。与对照组相比,高剂量阿托伐他汀显著降低了经皮冠状动脉介入治疗患者发生心肌梗死的风险(相对风险=0.62,95%置信区间:0.49-0.78),异质性水平较低(I=22.6%,P=0.228)。9项研究共2248例患者报告了心血管不良事件,采用固定效应模型。与对照组相比,服用高剂量阿托伐他汀的患者发生心血管不良事件的风险降低了65%(相对风险,RR=0.65,95%置信区间(CI):0.50-0.84),序贯试验分析证实累积Z曲线进入无效区域。亚组分析发现各试验中心肌梗死风险均降低(RR=0.64,95%CI:0.50-0.83;RR=0.55,95%CI:0.34-0.88)。Egger和Begg检验未发现发表偏倚(t=-1.670,P=0.129;Z=1.560,P=0.119)。使用高剂量阿托伐他汀可降低经皮冠状动脉介入治疗患者发生心肌梗死和心血管不良事件的风险。推荐高剂量阿托伐他汀作为经皮冠状动脉介入治疗的辅助用药。