原发性经皮冠状动脉介入术后低风险患者提前出院的安全性：最新系统回顾和元分析

IF 2.8 3区医学 Q1 Pharmacology, Toxicology and Pharmaceutics

Therapeutics and Clinical Risk Management Pub Date : 2024-03-06 DOI:10.2147/tcrm.s451598

Firman Sugiharto, Yanny Trisyani, Aan Nuraeni, Praneed Songwathana

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引用次数: 0

摘要

背景：低风险患者经皮冠状动脉介入治疗（PPCI）后的早期出院（ED）策略指南仍有待完善。以往的荟萃分析证据被认为存在局限性，包括异质性水平仍然较高，样本量仍需更大。目的：本研究旨在确定低风险患者经皮冠状动脉介入术后早期出院的安全性：文献检索使用了五个主要数据库：CINAHL、PubMed、ScienceDirect、Scopus、Taylor and Francis，以及一个搜索引擎：谷歌学者。两名审稿人使用 JBI 和 Cochrane 的 "偏倚风险 "工具对研究进行了独立筛选和严格评估。采用固定效应和随机效应模型收集标准化均值差异和风险差异。统计分析使用 Review Manager 5.3 和 JAMOVI 2.4.8.0 版本进行：定量分析包括 7 项研究性临床试验和 7 项队列研究，前者有 1 780 名患者，后者有 46 710 名患者。RCT分析结果显示，全因再入院（RD - 0.01; 95% CI: - 0.04 to 0.01; Z=1.20; p=0.23; I2=0%）和死亡率（RD 0.00; 95% CI: - 0.01 to 0.01; Z=0.01；p=0.99；I2=0%），并显著降低了以小时计算的 LOS（SMD - 2.32；95% CI：- 3.13 至 - 1.51；Z=5.64；p<；0.001；I2=93%）和以天计算的 LOS（SMD - 0.58；95% CI：- 1.00 至 - 0.17；Z=2.76；p=0.006；I2=84%）。此外，队列研究分析显示，急诊室策略与全因再入院（RD - 0.00; 95% CI: - 0.01 to - 0.00; Z=2.18; p=0.03; I2=0%）和死亡率（RD - 0.01; 95% CI: - 0.02 to - 0.00; Z=2.04; p=0.04; I2=94%）相关：结论：PPCI术后低风险患者的ED策略是完全安全的。结论：PPCI 术后低风险患者的 ED 策略是完全安全的，这一点从再入院率和死亡率无显著差异以及缩短住院时间中得到了证明。

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Safety of Early Discharge Among Low-Risk Patients After Primary Percutaneous Coronary Intervention: An Updated Systematic Review and Meta-Analysis

Background: Guidelines for early discharge (ED) strategies after primary percutaneous coronary intervention (PPCI) in low-risk patients still need to be informed. Previous meta-analysis evidence is considered to have limitations, from the level of heterogeneity, which is still relatively high, and the sample size still needed to be more significant.
Purpose: This study aims to identify the safety of early discharge after PPCI in low-risk patients
Methods: The literature search used five primary databases: CINAHL, PubMed, ScienceDirect, Scopus, Taylor and Francis, and one search engine: Google Scholar. Two reviewers independently screened and critically appraised studies using JBI’s and Cochrane’s Risk of Bias tool. Fixed and random effects model were applied to collect standardized mean differences and risk differences. Statistical analysis was performed using Review Manager 5.3 and JAMOVI version 2.4.8.0.
Results: Seven RCTs consisting of 1.780 patients and seven cohort studies consisting of 46.710 patients were included in the quantitative analysis. The results of the RCT analysis showed no significant differences in all-cause readmission (RD − 0.01; 95% CI: − 0.04 to 0.01; Z=1.20; p=0.23; I²=0%) and mortality (RD 0.00; 95% CI: − 0.01 to 0.01; Z=0.01; p=0.99; I²=0%) and also significant in reducing LOS in hour (SMD − 2.32; 95% CI: − 3.13 to − 1.51; Z=5.64; p< 0.001; I²=93%) and day (SMD − 0.58; 95% CI: - 1.00 to − 0.17; Z=2.76; p=0.006; I²=84%). In addition, analysis of cohort studies showed that ED strategy was associated with all-cause readmission (RD − 0.00; 95% CI: − 0.01 to − 0.00; Z =2.18; p=0.03; I²=0%) and mortality (RD − 0.01; 95% CI: − 0.02 to − 0.00; Z=2.04; p=0.04; I²=94%).
Conclusion: ED strategies in low-risk patients after PPCI can be completely safe. This is proven by the absence of significant differences in readmission and mortality rates as well as reduce the length of stay.

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来源期刊

Therapeutics and Clinical Risk Management HEALTH CARE SCIENCES & SERVICES-

CiteScore

5.30

自引率

3.60%

发文量

139

审稿时长

16 weeks

期刊介绍： Therapeutics and Clinical Risk Management is an international, peer-reviewed journal of clinical therapeutics and risk management, focusing on concise rapid reporting of clinical studies in all therapeutic areas, outcomes, safety, and programs for the effective, safe, and sustained use of medicines, therapeutic and surgical interventions in all clinical areas. The journal welcomes submissions covering original research, clinical and epidemiological studies, reviews, guidelines, expert opinion and commentary. The journal will consider case reports but only if they make a valuable and original contribution to the literature. As of 18th March 2019, Therapeutics and Clinical Risk Management will no longer consider meta-analyses for publication. The journal does not accept study protocols, animal-based or cell line-based studies.