背景:在急性冠状动脉综合征(ACS)和多支血管疾病(MVD)的患者中,完全血运重建(CR)改善预后。这个荟萃分析,总结最近的RCT,在即刻完全血运重建(ICR)和分期完全血运重建(SCR)之间,对比了短期和长期临床结局.
方法:我们系统检索了在线数据库,纳入了8个RCT。主要结果包括长期非计划性缺血驱动的血运重建,再梗死,合并心血管(CV)死亡或心肌梗死(MI),全因死亡,CV死亡,中风,心力衰竭(HHF)住院。次要结局为1个月非计划性缺血驱动的血运重建,再梗死,全因死亡,CV死亡安全性终点包括支架血栓形成和大出血。
结果:共纳入8个RCTs,包括5198例患者。ICR降低了长期非计划性缺血驱动的血运重建(RR0.64,95%CI0.51-0.81,p<0.001),合并CV死亡或MI(HR0.51,95%CI0.34-0.78,p=0.002),与SCR相比,再梗死(RR0.66,95%CI0.48至0.91,p=0.012)。ICR还降低了1个月非计划性缺血驱动的血运重建(RR0.41,95%CI:0.21-0.77,p=0.006)和再梗死(RR0.33,95%CI:0.15-0.74,p=0.007),但增加了1个月全因死亡(RR2.22,95%CI1.06-4.65,p=0.034)。
结论:在患有MVD的ACS患者中,我们首先发现ICR显著降低了短期和长期非计划性缺血驱动的血运重建和再梗死的风险,以及与SCR相比,CV死亡或MI的长期复合结局。然而,ICR组1个月全因死亡人数可能增加.
BACKGROUND: In patients with acute coronary syndrome (ACS) and multivessel disease (MVD), complete revascularization (CR) improves prognosis. This meta-analysis, summarizing recent RCTs, contrasts short-term and long-term clinical outcomes between immediate complete revascularization (ICR) and staged complete revascularization (SCR).
METHODS: We systematically searched the online database and eight RCTs were involved. The primary outcomes included long-term unplanned ischemia-driven revascularization, re-infarction, combined cardiovascular (CV) death or myocardial infarction (MI), all-cause death, CV death, stroke, and hospitalization for heart failure (HHF). The secondary outcomes were 1-month unplanned ischemia-driven revascularization, re-infarction, all-cause death, and CV death. Safety endpoints included stent thrombosis and major bleeding.
RESULTS: Eight RCTs comprising 5198 patients were involved. ICR reduced long-term unplanned ischemia-driven revascularization (RR 0.64, 95% CI 0.51-0.81, p < 0.001), combined CV death or MI (HR 0.51, 95% CI 0.34-0.78, p = 0.002), and re-infarction (RR 0.66,95% CI 0.48 to 0.91, p = 0.012) compared with SCR. ICR also decreased 1-month unplanned ischemia-driven revascularization (RR 0.41, 95% CI: 0.21-0.77, p = 0.006) and re-infarction (RR 0.33, 95% CI:0.15-0.74, p = 0.007) but increased 1-month all-cause death (RR 2.22, 95% CI 1.06-4.65, p = 0.034).
CONCLUSIONS: In ACS patients with MVD, we first found that ICR significantly lowered the risk of both short-term and long-term unplanned ischemia-driven revascularization and re-infarction, as well as the long-term composite outcome of CV death or MI compared with SCR. However, there may be an increase in 1-month all-cause death in the ICR group.