PCI术前应用IABP辅助治疗对于急性心肌梗死患者临床疗效的系统评价

Effects of inserting intra-aortic balloon pump before percutaneous coronary intervention in acute myocardial infarction patients

关键词:  急性心肌梗死  主动脉球囊反搏  经皮冠脉介入治疗  meta分析  系统评价

Key words:  acute myocardial infarction  intra-aortic balloon pump  percutaneous coronary intervention  meta-analysis  systematic review

摘要:

目的　评价行经皮冠脉介入治疗（PCI）之前应用主动脉球囊反搏（IABP）辅助治疗对于急性心肌梗死（AMI）患者的近远期临床疗效。 方法　通过检索PubMed、The Cochrane library、Medline、Embase、CBM、中国知网期刊数据库（CNKI）、万方、 维普等数据库，获取自2000年1月到2015年10月所有发表的有关急性心肌梗死患者在行PCI之前应用IABP辅助治疗的临床随机对照试验的相关文献，按照纳入和排除标准提取文献数据，采用Review Manager5.3软件进行荟萃分析,采用漏斗图检验发表偏倚。 结果　共纳入7项研究，样本量1107例，行PCI之前应用IABP不能改善AMI患者30 d及6个月的全因死亡率（RR 0.74,95%CI 0.40-1.36,P>0.05；RR 0.77,95%CI 0.40-1.48,P>0.05）；不能增加术后TIMI血流3级的人数（RR 1.03,95% CI 0.90-1.18,P>0.05）；但可减少30 d内的主要不良心血管事件（MACE）发生率,差异有显著性意义（RR 0.42，95%CI 0.29-0.62,P<0.05），出血事件发生率无显著增加（RR 2.11,95% CI 0.95-4.70,P>0.05）。亚组分析结果显示：早期运用IABP不能有效降低AMI合并心源性休克患者的全因死亡率（RR 0.97,95%CI 0.52-1.82,P>0.05），但可以减少不合并心源性休克患者的全因死亡率（RR 0.40,95% CI 0.18-0.85,P<0.05)。 结论　对于急性心肌梗死患者在行PCI术前应用IABP可以显著减少MACE事件的发生，但不能显著降低术后30 d、6个月的死亡率。

Abstract:

Objective　To systematically review the clinical curative effects of inserting intra-aortic balloon pump before percutaneous coronary intervention in acute myocardial infarction (AMI) patients. Methods　According to the inclusion and exclusion criteria, we searched all published randomized controlled trials (RCTs) on inserting IABP before PCI for the treatment of AMI form Jan, 2000 to Oct, 2015 in PubMed, the Cochrane library, Medline, Embase, CBM, CNKI, Wanfang, Vip and other related databases. Meta-analysis was conducted by using RevMan 5.3 software, and funnel-plot was used to assess the publication bias of included articles. Results　Seven trials with a total populations of 1107 patients were included in the analysis. Meta-analysis revealed that there was no significant difference in 30-days and 6-months all-cause mortality between the pre-using IABP before PCI group and the control group (RR 0.74,95% CI 0.40-1.36, P>0.05 and RR 0.77, 95% CI 0.40-1.48, P>0.05, respectively) and anticipatory use of IABP could not increase the number of TIMI grade 3 patients after PCI（RR 1.03, 95% CI 0.90-1.18, P>0.05). Major adverse cardiac events (MACE) were significantly reduced in the pre-using IABP before PCI group, and the difference was statistically significant (RR 0.42, 95% CI 0.29-0.62, P<0.05); the curative effect bleeding events were not increased significantly （RR 2.11, 95% CI 0.95-4.70, P>0.05). Subgroup analysis revealed that inserting IABP before PCI could not reduce the mortality of AMI patients complicated by cardiogenic shock （RR 0.97, 95% CI 0.52-1.82, P>0.05), but reduced the mortality of AMI patients without cardiogenic shock （RR 0.40,95 % CI 0.18-0.85,P<0.05). Conclusion　Inserting IABP before PCI is rewarding and reduces MACEs in AMI patients, but cannot significantly reduce the mortality within 30 days and 6 months .