不同血运重建策略在非st段抬高型心肌梗死合并多血管疾病患者中的疗效和安全性：一项系统综述和网络meta分析

IF 1.5 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Postepy W Kardiologii Interwencyjnej Pub Date : 2024-12-01 Epub Date: 2024-11-05 DOI:10.5114/aic.2024.144666

Tingting Chen, Chen Lu, Jingli Mo, Ting Wang, Xiang Li, Ying Yang

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引用次数: 0

摘要

非st段抬高型心肌梗死（NSTEMI）合并多血管疾病（MVD）的最佳血运重建时机仍存在争议。目的：我们研究不同血运重建策略对临床结果的影响，以评估这些患者的最佳血运重建策略。方法：我们对比较非stemi和MVD患者血运重建策略的队列研究进行了网络荟萃分析。使用随机效应模型以比值比（ORs）计算效应大小。主要疗效指标为全因死亡率，主要安全性指标为复发性心肌梗死。结果：8项符合条件的研究包括34,151例接受4种血运重建术的患者。与传统的罪魁祸首血运重建术（COR）相比，在第二次住院期间计划完成的多支经皮冠状动脉介入治疗（MV-PCI）降低了主要不良心血管事件（mace）的风险(MV-PCI vs. COR: OR = 0.53；95% CI: 0.38-0.74)和全因死亡率降低(MV-PCI vs. COR: OR = 0.53；95% CI: 0.30-0.93)和重复血运重建的可能性(MV-PCI vs. COR: OR = 0.55；95% ci: 0.37-0.82)。然而，与COR相比，立即完全血运重建术（ICR）而非MV-PCI与心肌梗死复发风险降低相关(COR vs. ICR: OR = 1.39；95% ci: 1.07-1.81；MV-PCI vs. COR: OR = 0.64；95% ci: 0.40-1.01)。与MV-PCI相比，指数PCI （SCR）期间的COR和分阶段完全血运重建术增加了心血管死亡的风险(MV-PCI vs. COR: OR = 0.48；95% ci: 0.34-0.70；MV-PCI与SCR: OR = 0.62；95% ci: 0.40-0.96)。与ICR相比，COR的心血管死亡率也明显更高(COR vs. ICR: OR = 1.38；95% ci: 1.02-1.85)。结论：在大多数随访中，完全血运重建术比单纯的罪魁祸首血运重建术更有效。

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Efficacy and safety of different revascularization strategies in patients with non-ST-segment elevation myocardial infarction with multivessel disease: a systematic review and network meta-analysis.

Introduction: The optimal timing of revascularization in non-ST-segment elevation myocardial infarction (NSTEMI) with multivessel disease (MVD) remains controversial.

Aim: We investigated the impact of different revascularization strategies on clinical outcomes to assess the optimal revascularization strategy for these patients.

Methods: We performed a network meta-analysis of cohort studies comparing revascularization strategies in NSTEMI with MVD. Effect sizes were calculated as odds ratios (ORs) using a random-effects model. The primary efficacy outcome was all-cause mortality and the primary safety outcome was recurrent myocardial infarction.

Results: Eight eligible studies involving 34,151 patients receiving four revascularization strategies were analyzed. Compared to conventional culprit-only revascularization (COR), planned complete multi-vessel percutaneous coronary intervention during a second hospitalization (MV-PCI) reduced the risk of major adverse cardiovascular events (MACEs) (MV-PCI vs. COR: OR = 0.53; 95% CI: 0.38-0.74) and decreased all-cause mortality (MV-PCI vs. COR: OR = 0.53; 95% CI: 0.30-0.93) and the likelihood of repeat revascularization (MV-PCI vs. COR: OR = 0.55; 95% CI: 0.37-0.82). However, compared to COR, immediate complete revascularization (ICR) but not MV-PCI was associated with reduced risk of recurrent MI (COR vs. ICR: OR = 1.39; 95% CI: 1.07-1.81; MV-PCI vs. COR: OR = 0.64; 95% CI: 0.40-1.01). Compared to MV-PCI: COR and staged complete revascularization during index PCI (SCR) increased the risk of cardiovascular mortality (MV-PCI vs. COR: OR = 0.48; 95% CI: 0.34-0.70; MV-PCI vs. SCR: OR = 0.62; 95% CI: 0.40-0.96). COR also had significantly higher cardiovascular mortality compared to ICR (COR vs. ICR: OR = 1.38; 95% CI: 1.02-1.85).

Conclusions: Complete revascularization is more effective compared to culprit-only revascularization for most follow-ups.

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来源期刊

Postepy W Kardiologii Interwencyjnej 医学-心血管系统

CiteScore

1.60

自引率

15.40%

发文量

审稿时长

6-12 weeks

期刊介绍： Postępy w Kardiologii Interwencyjnej/Advances in Interventional Cardiology is indexed in: Index Copernicus, Ministry of Science and Higher Education Index (MNiSW). Advances in Interventional Cardiology is a quarterly aimed at specialists, mainly at cardiologists and cardiosurgeons. Official journal of the Association on Cardiovascular Interventions of the Polish Cardiac Society.