Safety of early discharge after primary angioplasty in low-risk patients with ST-segment elevation myocardial infarction: A meta-analysis of randomised controlled trials
Safety of early discharge after primary angioplasty in low-risk patients with ST-segment elevation myocardial infarction: A meta-analysis of randomised controlled trials
复制标题
ST 段抬高型心肌梗死低危患者初次血管成形术后早期出院的安全性：随机对照试验的荟萃分析
DOI：
10.1177/2047487318763823
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发表时间：
2018-05-01
影响因子：
8.3
通讯作者：
Nie, Shaoping
中科院分区：
文献类型：
--
作者：
Gong, Wei;Li, Aobo;Nie, Shaoping
背景：成功的初次血管成形术后早期出院是很常见的，但支持这一做法的证据仍然缺乏。因此，我们进行了一项荟萃分析，评估低危ST段抬高型心肌梗死(STEMI)患者直接血管成形术后早期出院的安全性。方法从PubMed、Embase、Cochrane图书馆数据库和相关文献参考文献目录中检索随机对照试验。异质性分析采用I2检验。如果缺乏异质性，将使用固定效应模型进行荟萃分析，否则将使用随机效应模型。使用Review Manager 5.3进行统计分析。结果1575例STEMI患者的5个随机对照试验符合标准。Meta分析显示，早期出院策略组较常规出院策略组住院时间明显缩短(标准化均数差−1.46，95%可信区间−2.04~−0.88；P <； 0.0001)，死亡率和再住院率差异无统计学意义(风险比0.78，95%CI 0.50~1.22；P = 0.41)。结论这一荟萃分析的结果表明，在选定的低危STEMI患者中，成功的初次血管成形术后早期出院策略是安全的。较短的住院时间可能对患者和医疗保健系统都有利。
Background Early discharge after successful primary angioplasty is common, but the evidence supporting the practice is still lacking. We therefore performed a meta-analysis assessing the safety of early discharge after primary angioplasty in low-risk patients with ST-segment elevation myocardial infarction (STEMI). Methods Randomised controlled trials were identified and extracted from PubMed, Embase, Cochrane Library databases and reference lists of relevant papers. Heterogeneity was analysed using the I2 test. If there was a lack of heterogeneity, fixed effects models would be used for the meta-analysis, otherwise random effects models were used. Statistical analyses were performed using Review Manager 5.3. Results Five randomised controlled trials involving 1575 STEMI patients met the criteria. Meta-analysis showed that the early discharge strategy group had a significantly shortened length of hospital stay compared to the conventional discharge strategy group (standardised mean difference −1.46, 95% confidence interval (CI) −2.04 to −0.88; P < 0.0001), and there was no difference in mortality and readmission rates between the two groups (risk ratio 0.78, 95% CI 0.50 to 1.22; P = 0.41). Conclusions The findings of this meta-analysis suggested that the early discharge strategy after successful primary angioplasty is safe among selected low-risk STEMI patients. A shorter hospital stay could benefit both the patients and the healthcare systems.