■ST段抬高型心肌梗死(STEMI)和多支血管冠状动脉疾病(MVD)患者的非罪犯血管重建手术的最佳时机仍存在争议。我们的目的是探索接受MVD的STEMI患者经皮冠状动脉介入治疗(PCI)的最佳干预时间。
■PubMed/Medline,EMBASE,科克伦图书馆,和ClinicalTrials.gov数据库从开始到2024年1月1日进行了搜索,以比较STEMI患者的即时多支血管PCI和分期多支血管PCI的临床研究。主要结果是任何原因死亡,心血管死亡,非心源性死亡,心肌梗死(MI)和非计划性缺血驱动的血运重建。次要结果是缺血性卒中,支架内血栓形成,肾功能不全和大出血。用固定效应模型和随机效应模型计算风险比(RR)和赔率比(OR),计算95%置信区间(CI)。
■选择了5项随机试验纳入2,782例患者和6项前瞻性观察性研究纳入本荟萃分析。分期PCI组对心肌梗死(0.43,95%CI=0.27-0.67;P=0.0002)和非计划性缺血驱动的血运重建(0.57,95%CI=0.41-0.78;P=0.0004)的合并RRs明显较低。任何死因都没有显着差异,心血管死亡原因,或非心脏死亡原因。然而,现实世界中的前瞻性观察性研究结果表明,分期PCI组的全因死亡率的合并OR值显着降低(2.30,95%CI=1.22-4.34;P=0.01),心血管死亡(2.29,95%CI=1.10-4.77;P=0.03),非心血管死亡(3.46,95%CI=1.40-8.56;P=0.007)。
■根据我们的随机试验分析,与即时多支血管PCI相比,分期多支血管PCI显著降低了心肌梗死和非计划性缺血驱动的血运重建的风险.两组的全因死亡率无显著差异,心血管死亡率,或非心血管死亡风险。然而,前瞻性非随机研究提示,分期PCI组的死亡率可能有获益.因此,分期多支血管PCI可能是STEMI合并MVD患者的最佳PCI策略。
UNASSIGNED: The optimal timing for nonculprit vascular reconstruction surgery in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary disease (MVD) is still controversial. Our aim was to explore the optimal intervention time for percutaneous coronary intervention (PCI) in STEMI patients who underwent MVD.
UNASSIGNED: The PubMed/Medline, EMBASE, Cochrane Library, and ClinicalTrials.gov databases were searched from inception to January 1, 2024 for clinical studies comparing immediate multivessel PCI and staged multivessel PCI in patients with STEMI. The primary outcomes were death from any cause, cardiovascular death, noncardiac death, myocardial infarction (MI) and unplanned ischemia-driven revascularization. The secondary outcomes were ischemic stroke, stent thrombosis, renal dysfunction and major bleeding. The risk ratios (RRs) and odds ratios (ORs) were calculated with fixed-effects models and random-effects models, and 95% confidence intervals (CIs) were calculated.
UNASSIGNED: Five randomized trials with 2,782 patients and six prospective observational studies with 3,131 patients were selected for inclusion in this meta-analysis. The staged PCI group had significantly lower pooled RRs for myocardial infarction (0.43, 95% CI = 0.27-0.67; P = 0.0002) and unplanned ischemia-driven revascularization (0.57, 95% CI = 0.41-0.78; P = 0.0004). There were no significant differences in any cause of death, cardiovascular cause of death, or noncardiac cause of death. However, the results of prospective observational studies in the real world indicated that the staged PCI group had significantly lower pooled ORs for all-cause mortality (2.30, 95% CI = 1.22-4.34; P = 0.01), cardiovascular death (2.29, 95% CI = 1.10-4.77; P = 0.03), and noncardiovascular death (3.46, 95% CI = 1.40-8.56; P = 0.007).
UNASSIGNED: According to our randomized trial analysis, staged multivessel PCI significantly reduces the risk of myocardial infarction and unplanned ischemia-driven revascularization compared to immediate multivessel PCI. There was no significant difference between the two groups in terms of all-cause mortality, cardiovascular mortality, or noncardiovascular mortality risk. However, prospective non-randomized studies suggest there might be a benefit in mortality in the staged PCI group. Therefore, staged multivessel PCI may be the optimal PCI strategy for STEMI patients with MVD.