中国人群急诊PCI与先溶栓后择期行PCI治疗急性心肌梗死的疗效和安全性荟萃分析

庞军; 张钲; 白明; 李娜; 李强; 张锦; 张博; 彭瑜; 张静

doi:10.13201/j.issn.1001-1439.2014.04.016

中国人群急诊PCI与先溶栓后择期行PCI治疗急性心肌梗死的疗效和安全性荟萃分析

- 1 兰州大学第一临床医学院(兰州, 730000);
- 2 兰州大学第一医院心内科;
- 3 北京市中国医学科学院北京协和医学院国家心血管病中心阜外心血管病医院

详细信息

通讯作者: 张钲, E-mail:Zhangccu@163.com

中图分类号: R542.2

收稿日期: 2013-11-22

Efficacy and safety of emergency PCI and elective PCI after thrombolysis for acute myocardial infarction:a Meta-analysis

- 1 the First Clinical Medical College, Lanzhou University, Lanzhou, 730000, China;
- 2 Department of Cardiclogy, the First Hospital;
- 3 Peking Union Medical College

More Information

Corresponding author: ZHANG Zheng, E-mail: Zhangccu@163.com

Received Date: 22 November 2013

摘要

摘要: 目的:系统评价急诊PCI与择期PCI治疗急性心肌梗死的疗效和安全性。方法:计算机检索PubMed、Embase、Cochrane图书馆、CNKI、VIPH和万方数据库, 检索时间截止2013年10月。纳入有关中国人群急诊PCI与先溶栓后择期行PCI治疗急性心肌梗死的RCT试验, 由2名研究者对纳入文献进行评价和资料提取, 根据Cochrane Handbook 5.0.2质量评价标准评价纳入研究质量。采用RevMan5.0软件对数据进行定量合并。结果:本文最终纳入9个RCT, 共包括1 058例患者, 急诊PCI组516例, 择期PCI组542例。Meta分析结果显示:急诊PCI相对于择期PCI较少发生术后全因死亡 (OR=0.16, 95%CI:0.05~0.51) 和再发心绞痛 (OR=0.59, 95%CI:0.39~0.88), 且能更有效降低患者血清NT-proBNP水平。而两组在手术成功率 (OR=0.92, 95%CI:0.33~2.59)、术后恶性心律失常发生 (OR=1.28, 95%CI:0.17~9.67)、PCI术后出血 (OR=1.00, 95%CI:0.01~99.57) 指标上无统计学差异。同时, 急诊与择期PCI术后3个月均可改善左心室射血分数。结论:中国人群急诊PCI与先溶栓后择期行PCI手术成功率、术后恶性心律失常发生、PCI术后出血等方面与择期PCI相似, 而急诊PCI组在全因死亡率死亡及再发心绞痛方面优于先溶栓后择期行PCI组, 故在有条件的情况下推荐使用急诊PCI。
- 急性心肌梗死 /
- 经皮冠状动脉介入治疗 /
- meta分析
Abstract: Objective:To evaluate the efficacy and safety of emergency PCI and rescue PCI in the treatment of acute myocardial infarction (AMI).Method:Computer retrival PubMed, Embase, Cochrane Library, CNKI, VIPH and Wanfang databank, the deadline was October 2013.We selected the clinical trails of emergency PCI VS rescue PCI in the treatment of AMI, following the Cochrane H and book 5.0.2 evaluation criteria.The data were merged by RevMan 5.0 software.Result:We finally included 9 RCTs, including a total of 1 058 patients, 516 cases of emergency PCI group, 542 cases of elective PCI group.The Meta analysis results showed that comparing to rescue PCI, emergency PCI tended to be less incidence both in all-cause death (OR=0.16, 95%CI:0.05~0.51) and recurrence incidence of angina (OR=0.59, 95%CI:0.39~0.88).And emergency PCI could reduce serum NT-proBNP levels more effectively.Meanwhile, there were no significant differences between PCI success, the postoperative malignant arrhythmia, and PCI postoperative bleeding.The two methods could improve left ventricular ejection fraction (LVEF).Conclusion:The PCI success rate, malignant arrhythmia after PCI, and bleeding after PCI are similar between emergency PCI and rescue PCI, however the emergency PCI has lower incidence of allcause mortality and mortality caused by respect recurrent angina.So emergency PCI is recommended when conditions permit.
- acute myocardial infarction /
- PCI /
- Meta analysis

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