伴有和不伴有标准可改变危险因素的ST段抬高型心肌梗死患者在治疗和结局方面的差异：一项系统评价和荟萃分析

Differences in treatment and outcomes among patients with ST-segment elevation myocardial infarction with and without standard modifiable risk factors: a systematic review and meta-analysis.

作者信息

Shrestha Biraj, Shrestha Dhan B, Sedhai Yub R, Shtembari Jurgen, Oli Prakash R, Shikhrakar Shreeja, Paudel Bidhya, Roberts Madhur, Patel Nimesh K, Singh Aniruddha, Singh Karan, Waheed Irfan, Basnyat Soney, Khan Mohammad S, Kazimuddin Mohammed, Elgendy Islam Y

机构信息

Department of Internal Medicine, Tower Health Program.

Department of Internal Medicine, Mount Sinai Hospital, Chicago.

出版信息

Ann Med Surg (Lond). 2023 May 3;85(6):2916-2923. doi: 10.1097/MS9.0000000000000738. eCollection 2023 Jun.

DOI:10.1097/MS9.0000000000000738

PMID:37363488

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10289527/

Abstract

UNLABELLED

There are limited data available on outcomes and pathophysiology behind ST-segment elevation myocardial infarction (STEMI) in populations without standard modifiable risk factors (SMuRFs). The authors carried out this meta-analysis to understand the differences in treatment and outcomes of STEMI patients with and without SMuRFs.

METHODS

A systematic database search was performed for relevant studies. Studies reporting desired outcomes among STEMI patients with and without SMuRFs were selected based on predefined criteria in the study protocol (PROSPERO: CRD42022341389). Two reviewers independently screened titles and abstracts using Covidence. Full texts of the selected studies were independently reviewed to confirm eligibility. Data were extracted from all eligible studies via a full-text review of the primary article for qualitative and quantitative analysis. In-hospital mortality following the first episode of STEMI was the primary outcome, with major adverse cardiovascular events (MACE), repeat myocardial infarction (MI), cardiogenic shock, heart failure, and stroke as secondary outcomes of interest. Odds ratio (OR) with a 95% CI was used to estimate the effect.

RESULTS

A total of 2135 studies were identified from database search, six studies with 521 150 patients with the first STEMI episode were included in the analysis. The authors found higher in-hospital mortality (OR: 1.43; CI: 1.40-1.47) and cardiogenic shock (OR: 1.59; 95% CI: 1.55-1.63) in the SMuRF-less group with no differences in MACE, recurrent MI, major bleeding, heart failure, and stroke. There were lower prescriptions of statin (OR: 0.62; CI: 0.42-0.91) and Angiotensin converting enzyme inhibitor /Angiotensin II receptor blocker (OR: 0.49; CI: 0.28-0.87) at discharge in SMuRF-less patients. There was no difference in procedures like coronary artery bypass graft, percutaneous coronary intervention, and thrombolysis.

CONCLUSION

In the SMuRF-less STEMI patients, higher in-hospital mortality and treatment discrepancies were noted at discharge.

摘要

未标注

关于无标准可改变风险因素（SMuRFs）人群中ST段抬高型心肌梗死（STEMI）的预后和病理生理学的数据有限。作者进行了这项荟萃分析，以了解有和没有SMuRFs的STEMI患者在治疗和预后方面的差异。

方法

对相关研究进行系统的数据库检索。根据研究方案（PROSPERO：CRD42022341389）中的预定义标准，选择报告有和没有SMuRFs的STEMI患者的预期预后的研究。两名评审员使用Covidence独立筛选标题和摘要。对所选研究的全文进行独立评审以确认其合格性。通过对主要文章的全文评审从所有合格研究中提取数据，进行定性和定量分析。首次STEMI发作后的住院死亡率是主要结局，主要不良心血管事件（MACE）、再次心肌梗死（MI）、心源性休克、心力衰竭和中风是感兴趣的次要结局。使用95%置信区间的比值比（OR）来估计效应。

结果

通过数据库检索共识别出2135项研究，分析纳入了6项研究，共521150例首次发生STEMI的患者。作者发现，在无SMuRFs组中，住院死亡率更高（OR：1.43；CI：1.40 - 1.47），心源性休克发生率更高（OR：1.59；95%CI：1.55 - 1.63），而在MACE、复发性MI、大出血、心力衰竭和中风方面无差异。无SMuRFs的患者出院时他汀类药物（OR：0.62；CI：0.42 - 0.91）和血管紧张素转换酶抑制剂/血管紧张素II受体阻滞剂（OR：0.49；CI：0.28 - 0.87）的处方量较低。在冠状动脉旁路移植术、经皮冠状动脉介入治疗和溶栓等操作方面没有差异。