Percutaneous Coronary Intervention Versus Optimal Medical Therapy for Prevention of Spontaneous Myocardial Infarction in Subjects With Stable Ischemic Heart Disease
Percutaneous Coronary Intervention Versus Optimal Medical Therapy for Prevention of Spontaneous Myocardial Infarction in Subjects With Stable Ischemic Heart Disease
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DOI：
10.1161/circulationaha.112.131961
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发表时间：
2013-02-19
期刊：
影响因子：
37.8
通讯作者：
Bagos, Pantelis G.
中科院分区：
文献类型：
--
作者：
Bangalore, Sripal;Pursnani, Seema;Bagos, Pantelis G.
背景-当代研究表明，自发性而非程序性心肌梗死(MI)与随后的死亡率相关。经皮冠状动脉介入治疗(PCI)是否能减少自发性(非程序性)MI尚不清楚。方法与结果--检索PubMed、EMBASE和Cochrane Central Register of Control Trials(CENTAL)，进行随机临床试验，直到2012年10月，比较经皮冠状动脉介入治疗(PCI)与最佳药物治疗(OMT)治疗稳定性缺血性心脏病的疗效，并报告MI结果：自发性非程序性MI、程序性MI和所有MI，包括与程序相关的MI。考虑到试验之间的随访时间长短不同，使用了混合效应泊松回归荟萃分析。在12项随机临床试验中，与单纯OMT相比，与单纯OMT相比，在存在更高的程序性MI发生率(IRR=4.11；95%CI，2.53-6.88)的风险下，与单纯OMT相比，自发性非程序性MI的发生率(IRR=0.76；95%可信区间[CI]，0.58-0.99)显著降低，而对所有MI的风险没有任何差异(IRR=0.96；95%CI，0.74-1.21)。在全原因死亡率(IRR=0.88；95%CI，0.75-1.03)和心血管死亡率(IRR=0.70；95%CI，0.44-1.09)方面，经皮冠状动脉介入治疗与OMT相比与自发性非程序性心肌梗死(但不是程序性或全部非致死性心肌梗死)的点估计值相当，尽管这些差异无统计学意义。结论：与OMT相比，经皮冠状动脉介入治疗减少了自发性心肌梗死的风险，但在所有MI方面没有任何差异。与先前的研究表明自发性心肌梗死而不是程序性心肌梗死与随后的死亡率有关，在本报告中，与OMT相比，经皮冠状动脉介入治疗降低死亡率的点估计与通过经皮冠状动脉介入治疗预防自发性心肌梗死平行。需要进一步的研究来确定这些联系是否是因果关系。(发行量。2013；127：769-781。)
Background-Contemporary studies have shown that spontaneous but not procedural myocardial infarction (MI) is related to subsequent mortality. Whether percutaneous coronary intervention (PCI) reduces spontaneous (nonprocedural) MI is unknown.Methods and Results-PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for randomized clinical trials until October 2012 comparing PCI with optimal medical therapy (OMT) for stable ischemic heart disease and reporting MI outcomes: spontaneous nonprocedural MI, procedural MI, and all MI, including procedure-related MI. Given the varying length of follow-up between trials, a mixed-effect Poisson regression meta-analysis was used. From 12 randomized clinical trials with 37 548 patient-years of follow-up, PCI compared with OMT alone was associated with a significantly lower incident rate ratio (IRR) for spontaneous nonprocedural MI (IRR=0.76; 95% confidence interval [CI], 0.58-0.99) at the risk of a higher rate of procedural MI (IRR=4.11; 95% CI, 2.53-6.88) without any difference in the risk of all MI (IRR=0.96; 95% CI, 0.74-1.21). The point estimate for PCI versus OMT for all-cause mortality (IRR=0.88; 95% CI, 0.75-1.03) and cardiovascular mortality (IRR=0.70; 95% CI, 0.44-1.09) paralleled that for spontaneous nonprocedural MI (but not procedural or all nonfatal MI), although these were not statistically significant.Conclusions-PCI compared with OMT reduced spontaneous MI at the risk of procedural MI without any difference in all MI. Consistent with prior studies showing that spontaneous MI but not procedural MI is related to subsequent mortality, in the present report the point estimate for reduced mortality with PCI compared with OMT paralleled the prevention of spontaneous MI with PCI. Further studies are needed to determine whether these associations are causal. (Circulation. 2013;127:769-781.)