经皮冠状动脉介入治疗的冠心病患者主要不良心血管事件危险因素的系统评价

A Systematic Review of risk factors for major adverse cardiovascular events in patients with coronary heart disease who underwent percutaneous coronary intervention.

作者信息

Zhai You, Shang Hongcai, Li Yan, Zhang Nan, Zhang Jisi, Wu Shangwen

机构信息

Henan University of Chinese Medicine, Zhengzhou, Henan, China.

Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.

出版信息

Front Physiol. 2025 Apr 9;16:1514585. doi: 10.3389/fphys.2025.1514585. eCollection 2025.

DOI:10.3389/fphys.2025.1514585

PMID:40271216

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12014560/

Abstract

OBJECTIVE

This study aims to systematically review the risk factors for major adverse cardiovascular events (MACE) in patients with coronary heart disease who have undergone percutaneous coronary intervention (PCI).

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

The Cochrane Library, PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Database, and VIP Database for Chinese Technical Periodicals (VIP) were screened until December 2024.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Case-control studies or cohort studies on the risk factors for MACE in patients with coronary heart disease who underwent PCI. Data extraction and synthesis: The literature review, data extraction, and quality evaluation were conducted by two independent researchers, and the meta-analysis was performed using RevMan 5.4 software.

MAIN OUTCOMES

The main outcome was that MACE occurred during the follow-up period.

RESULTS

A total of 40 articles were included. The meta-analysis erevealed that dyslipidemia (OR = 1.50; 95% CI [1.19, 1.89], = 0.0007), diabetes mellitus (OR = 1.70; 95% CI [1.43, 2.02], < 0.00001), hypertension (OR = 1.62; 95% CI [1.35, 1.96], < 0.0001), history of smoking (OR = 2.08; 95% CI [1.51, 2.85], < 0.0001), poorer ventricular function (OR = 2.39; 95% CI [2.17-2.64], < 0.0001), impaired left ventricular ejection fraction (LVEF) (OR = 1.86; 95% CI [1.71-2.03], < 0.0001), door to balloon (D-to-B) time (OR = 0.61; 95% CI [0.42-0.88]; = 0.009), thrombolysis in myocardial infarction (TIMI) (OR = 1.41; 95% CI [1.17, 1.70], = 0.0004), renal dysfunction (OR = 1.82; 95% CI [1.37, 2.43], < 0.0001), and multi-vessel coronary artery disease (OR = 0.41; 95% CI [0.37, 0.46], < 0.0001) were significantly associated with MACE after PCI.

CONCLUSION

The independent risk factors of MACE after PCI are dyslipidemia, hypertension, diabetes mellitus, smoking history, Killip class > II, LVEF ≤40%, D-to-B time >90 min, TIMI flow grade ≤ II, renal insufficiency, and multivessel disease.

摘要

目的

本研究旨在系统评价接受经皮冠状动脉介入治疗（PCI）的冠心病患者发生主要不良心血管事件（MACE）的危险因素。

设计

系统评价和荟萃分析。

数据来源

检索Cochrane图书馆、PubMed、Web of Science、中国知网（CNKI）、万方数据库和维普中文科技期刊数据库（VIP），检索截至2024年12月的文献。

研究选择的纳入标准

关于接受PCI的冠心病患者发生MACE危险因素的病例对照研究或队列研究。数据提取与合成：由两名独立研究人员进行文献回顾、数据提取和质量评估，并使用RevMan 5.4软件进行荟萃分析。

主要结局

主要结局为随访期间发生MACE。

结果

共纳入40篇文章。荟萃分析显示，血脂异常（比值比[OR]=1.50；95%置信区间[CI][1.19，1.89]，P=0.0007）、糖尿病（OR=1.70；95%CI[1.43，2.02]，P<0.00001）、高血压（OR=1.62；95%CI[1.35，1.96]，P<0.0001）、吸烟史（OR=2.08；95%CI[1.51，2.85]，P<0.0001）、心室功能较差（OR=2.39；95%CI[2.17-2.64]，P<0.0001）、左心室射血分数（LVEF）受损（OR=1.86；95%CI[1.71-2.03]，P<0.0001）、门球时间（D-to-B）（OR=0.61；95%CI[0.42-0.88]；P=0.009）、心肌梗死溶栓（TIMI）（OR=1.41；95%CI[1.17，1.70]，P=0.0004）、肾功能不全（OR=1.82；95%CI[1.37，2.43]，P<0.0001）和多支冠状动脉疾病（OR=0.41；95%CI[0.37，0.46]，P<0.0001）与PCI术后MACE显著相关。