在患有ST段升高心肌梗塞和多血管疾病的患者中进行干预的最佳时间:系统性审查和元分析
Yi Chen1, Meng Li1, Yanqing Wu1
1The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
Frontiers in cardiovascular medicine
|August 26, 2024
概括
对于ST升高心肌梗塞 (STEMI) 患有多血管冠状动脉疾病 (MVD) 的患者,分阶段穿皮冠状动脉干预 (PCI) 与即时PCI相比,显著降低心肌梗塞和再血管化的风险. 观察数据还表明,分阶段的PCI对死亡率有潜在的益处.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 心血管研究研究心血管研究
背景情况:
- 在ST段升高心肌梗塞 (STEMI) 与多血管冠状动脉疾病 (MVD) 中进行非罪祸首血管重建的最佳时间仍在争论中.
- 对于STEMI患者中MVD的穿皮冠状动脉干预 (PCI) 策略需要进一步澄清.
研究的目的:
- 确定通过皮肤进行冠状动脉干预 (PCI) 的最佳时间,在患有多血管冠状动脉疾病 (MVD) 的STEMI患者中.
- 在STEMI患者中比较立即与分阶段的多血管PCI.
主要方法:
- 对随机试验和前性观察性研究进行了元分析.
- 搜索的数据库包括PubMed/Medline,EMBASE,Cochrane图书馆和临床试验.gov,截至2024年1月1日.
- 主要结局包括全因死亡,心血管死亡,心肌梗塞和无计划的再血管化.
主要成果:
- 在随机试验中,分阶段的PCI显著降低了心肌梗塞 (MI) 和计划外的再血管化,而不是立即的PCI.
- 在随机试验中,在立即和分阶段的PCI之间没有观察到死亡率的显著差异.
- 前性观察性研究表明,随着分阶段的PCI,所有原因和心血管死亡率的潜在降低.
结论:
- 根据随机试验数据,分阶段的多血管PCI似乎是减少MVD的STEMI患者的MI和再血管化的优越策略.
- 虽然随机试验没有显示死亡益处,但观察数据表明分阶段的PCI可能会改善存活率.
- 需要进一步调查分阶段PCI在MVD的STEMI中对死亡率的好处.
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