Liu Xuan-Yan, Li Yan-Yan, Wu Xian-Dan, Lin Yue, Lin Xian, Ye Bin-Hua, Sun Jing-Chao
Department of General Medicine, The First people's hospital of Wenling, Taizhou, 317500, Zhejiang, China.
Department of Cardiology, Taizhou Municipal Hospital, No.381 Zhongshan East Road, Taizhou, 317700, Zhejiang, China.
BMC Cardiovasc Disord. 2024 Dec 20;24(1):724. doi: 10.1186/s12872-024-04414-9.
The optimal timing of complete revascularization (CR) in patients with acute coronary syndrome (ACS) and multivessel disease (MVD) is still debated. The safety and efficacy of immediate and staged CR (ICR vs. SCR) in this patient group were thus compared.
PubMed, Embase, and CENTRAL were systematically searched to identify randomized controlled trials of CR strategies for MVD. Studies comparing cardiovascular benefits between ICR and SCR in ACS patients with MVD were included. Short- and long-term outcomes were compared using random-effect risk ratios (RRs). The analysis included seven studies with 3445 patients. The ICR and SCR groups showed comparable risks of all-cause death at 1 year (RR: 1.18; 95% CI: 0.72 to 1.95), but the risk increased at 1 month in ICR patients (RR: 2.35; 95% CI: 1.12 to 4.91). ICR reduced the risk of myocardial infarction (MI, RR: 0.54; 95% CI: 0.33 to 0.90) and target vessel revascularization (TVR, RR: 0.62; 95% CI: 0.45 to 0.85) at 1 year.
The all-cause death rates were comparable between ICR and SCR strategies. CR at index procedure could reduce MI and TVR rates at 1 year (46% and 38%, respectively). Future studies need to obtain more precise evidence and identify the cardiovascular benefits of these two strategies.
Not applicable.
急性冠状动脉综合征（ACS）合并多支血管病变（MVD）患者完全血运重建（CR）的最佳时机仍存在争议。因此，比较了该患者群体中即刻与分期CR（ICR与SCR）的安全性和有效性。
系统检索了PubMed、Embase和CENTRAL，以确定MVD的CR策略随机对照试验。纳入了比较ICR与SCR对ACS合并MVD患者心血管益处的研究。使用随机效应风险比（RR）比较短期和长期结局。分析纳入了7项研究，共3445例患者。ICR组和SCR组在1年时全因死亡风险相当（RR：1.18；95%CI：0.72至1.95），但ICR患者在1个月时风险增加（RR：2.35；95%CI：1.12至4.91）。ICR降低了1年时心肌梗死（MI，RR：0.54；95%CI：0.33至0.90）和靶血管血运重建（TVR，RR：0.62；95%CI：0.45至0.85）的风险。
ICR和SCR策略的全因死亡率相当。首次手术时进行CR可降低1年时的MI和TVR发生率（分别为46%和38%）。未来的研究需要获得更精确的证据，并确定这两种策略的心血管益处。
不适用。
