Liu Mei-Jun, Chen Chao-Feng, Gao Xiao-Fei, Liu Xiao-Hua, Xu Yi-Zhou
Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Coron Artery Dis. 2020 May;31(3):208-214. doi: 10.1097/MCA.0000000000000813.
Several studies have evaluated the long-term clinical outcomes of periprocedural myocardial injury for chronic total occlusions patients. However, the results of these studies were inconsistent. To determine whether the periprocedural myocardial injury has adverse effects on long-term clinical outcomes in chronic total occlusion patients undergoing percutaneous coronary intervention.
We searched Cochrane Library, PubMed, and Embase for eligible articles from their date of inception up to March 2019. Long-term clinical outcomes included major adverse cardiac events, all-cause death, cardiac death, myocardial infarction, and target vessel revascularization. Odds ratios with 95% confidence intervals were calculated as summary statistics by using Review Manager software.
A total of 8 observational studies involving 5879 chronic total occlusions patients were included in this meta-analysis. These results of this meta-analysis indicated that periprocedural myocardial injury was associated with a higher risk of major adverse cardiac events (odds ratio, 1.94; 95% confidence interval, 1.22-3.08; P = 0.005), a higher risk of all-cause death (odds ratio, 1.30; 95% confidence interval, 1.02-1.64; P = 0.03), a higher risk of cardiac death (odds ratio, 2.59; 95% confidence interval, 1.41-4.78; P = 0.002), a higher risk of myocardial infarction (odds ratio, 3.07; 95% confidence interval, 1.90-4.98; P < 0.00001), and a higher risk of target vessel revascularization (odds ratio, 2.07; 95% confidence interval, 1.35-3.16; P=0.0008) than non-periprocedural myocardial injury.
Periprocedural myocardial injury was associated with significantly increased risk of major adverse cardiac events, all-cause death, cardiac death, myocardial infarction, and target vessel revascularization in chronic total occlusion patients undergoing percutaneous coronary intervention at long-term follow-up.
多项研究评估了慢性完全闭塞患者围手术期心肌损伤的长期临床结局。然而，这些研究结果并不一致。旨在确定围手术期心肌损伤对接受经皮冠状动脉介入治疗的慢性完全闭塞患者的长期临床结局是否有不良影响。
我们在Cochrane图书馆、PubMed和Embase中检索了从创刊至2019年3月的符合条件的文章。长期临床结局包括主要不良心脏事件、全因死亡、心源性死亡、心肌梗死和靶血管血运重建。使用Review Manager软件计算比值比及95%置信区间作为汇总统计量。
本荟萃分析共纳入8项观察性研究，涉及5879例慢性完全闭塞患者。该荟萃分析结果表明，与非围手术期心肌损伤相比,围手术期心肌损伤与更高的主要不良心脏事件风险（比值比1.94；95%置信区间为1.22 - 3.08；P = 0.005）、更高的全因死亡风险（比值比1.30；95%置信区间为1.02 - 1.64；P = 0.03）、更高的心源性死亡风险（比值比2.59；95%置信区间为1.41 - 4.78；P = 0.002）、更高的心肌梗死风险（比值比3.07；95%置信区间为1.90 - 4.98；P < 0.00001）以及更高的靶血管血运重建风险（比值比2.07；95%置信区间为1.35 - 3.16；P = 0.0008）相关。
在接受经皮冠状动脉介入治疗的慢性完全闭塞患者的长期随访中，围手术期心肌损伤与主要不良心脏事件、全因死亡、心源性死亡、心肌梗死和靶血管血运重建风险的显著增加相关。
