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IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology Pub Date : 2024-12-12 DOI:10.1016/j.amjcard.2024.12.013

Abdulrahman M Almizel, Jeremy Y Levett, Tetiana Zolotarova, Mark J Eisenberg

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引用次数: 0

摘要

ST 段抬高型心肌梗死（STEMI）患者在接受初级经皮冠状动脉介入治疗（PCI）时常常伴有多支血管冠状动脉疾病（CAD），而在这些病例中进行完全血运重建（CR）的最佳时机仍不确定。本研究旨在评估STEMI多支血管CAD患者接受即刻（指数手术）与分期CR治疗的主要不良心血管事件（MACE）和手术并发症。我们对 STEMI 和多支血管并发症的随机对照试验（RCT）进行了系统回顾和荟萃分析，比较了立即和分阶段完全血管再通（CR）治疗 STEMI 和多支血管并发症的效果。这些试验是通过系统检索 MEDLINE、Embase 和 Cochrane Libraries（从数据库开始到 2024 年 3 月 6 日）而确定的。数据使用 RevMan 软件进行分析。我们的研究共纳入了五项 RCT（n=1,415），结果显示在 MACE（13.3% vs. 9.8%；RR：1.07，95% CI [0.62，1.83]）、全因死亡率（3% vs. 4.55%；RR：0.05，95% CI [0.62，1.83]）方面没有显著差异。加权平均随访时间为 16 个月，心肌梗死（4.5% 对 2.6%；RR：1.43，95% CI [0.58，3.55]）发生率为 4.55%；RR：0.70，95% CI [0.41，1.21]。然而，分期组的非计划性血管再通率更高（8.6% 对 4.4%；RR：1.92，95% CI [1.21，3.04]）。总之，对于患有多血管 CAD 的 STEMI 患者，在平均约 1.3 年的随访中，立即进行血管重建与分阶段血管重建在 MACE 方面没有显著差异；但是，分阶段血管重建与计划外缺血驱动的血管重建发生率显著升高有关。在指数住院期间进行分阶段血运重建可能与立即进行完全血运重建同样有效；需要进一步的试验来证实这一点。摘要我们对 5 项随机对照试验进行了荟萃分析，这些试验比较了 STEMI 多血管 CAD 患者立即和分阶段血管再通的效果。在主要不良心血管事件、全因死亡率和心肌梗死发生率方面，立即完全血运重建和分期完全血运重建没有明显差异。但是，分阶段血管重建与计划外缺血驱动的血管重建发生率较高有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Meta-analysis comparing immediate versus staged complete revascularization for ST-elevation myocardial infarction with multivessel disease.

Patients with ST-segment elevation myocardial infarction (STEMI) frequently present with multivessel coronary artery disease (CAD) during primary percutaneous coronary intervention (PCI), and the optimal timing of complete revascularization (CR) in these cases remains uncertain. This study aims to assess major adverse cardiovascular events (MACE) and procedural complications in STEMI patients with multivessel CAD undergoing immediate (index procedure) versus staged CR. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing immediate to staged complete revascularization (CR) in STEMI and multivessel CAD. Trials were identified via a systematic search of MEDLINE, Embase, and Cochrane Libraries from database inception to March 6, 2024. The data were analyzed using RevMan software. Five RCTs (n=1,415) were included in our study, which showed no significant differences in MACE (13.3% vs. 9.8%; RR: 1.07, 95% CI [0.62, 1.83]), all-cause mortality (3% vs. 4.55%; RR: 0.70, 95% CI [0.41, 1.21]), or myocardial infarction (4.5% vs. 2.6%; RR: 1.43, 95% CI [0.58, 3.55]) at a weighted mean follow-up duration of 16 months. However, the staged group had a higher rate of unplanned revascularization (8.6% vs. 4.4%; RR: 1.92, 95% CI [1.21, 3.04]). In conclusion, in STEMI patients with multivessel CAD, at a mean follow-up of approximately 1.3 years, there is no significant difference in immediate versus staged revascularization for MACE; however, staged revascularization was associated with a significantly higher incidence of unplanned ischemia-driven revascularization. Staged revascularization within the index hospitalization may be as effective as immediate complete revascularization; further trials are needed to confirm this. CONDENSED ABSTRACT We conducted a meta-analysis of 5 randomized controlled trials comparing immediate to staged CR in STEMI patients with multivessel CAD. There was no significant difference in major adverse cardiovascular events, all-cause mortality, and myocardial infarction rates between immediate and staged complete revascularization. However, staged revascularization was associated with a higher incidence of unplanned ischemia-driven revascularization.

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来源期刊

American Journal of Cardiology 医学-心血管系统

CiteScore

4.00

自引率

3.60%

发文量

698

审稿时长

33 days

期刊介绍： Published 24 times a year, The American Journal of Cardiology® is an independent journal designed for cardiovascular disease specialists and internists with a subspecialty in cardiology throughout the world. AJC is an independent, scientific, peer-reviewed journal of original articles that focus on the practical, clinical approach to the diagnosis and treatment of cardiovascular disease. AJC has one of the fastest acceptance to publication times in Cardiology. Features report on systemic hypertension, methodology, drugs, pacing, arrhythmia, preventive cardiology, congestive heart failure, valvular heart disease, congenital heart disease, and cardiomyopathy. Also included are editorials, readers'' comments, and symposia.