Survival After Varying Revascularization Strategies in Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Artery Disease A Pairwise and Network Meta-Analysis
Survival After Varying Revascularization Strategies in Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Artery Disease A Pairwise and Network Meta-Analysis
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DOI：
10.1016/j.jcin.2016.06.012
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发表时间：
2016-09-12
影响因子：
11.3
通讯作者：
Stone, Gregg W.
中科院分区：
文献类型：
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作者：
Tarantini, Giuseppe;D'Amico, Gianpiero;Stone, Gregg W.
目的 作者进行了系统的成对和网络荟萃分析，以评估接受直接经皮冠状动脉介入治疗 (PCI) 的 ST 段抬高型心肌梗死 (STEMI) 和多支冠状动脉疾病 (MV-CAD) 患者的最佳治疗策略。 背景 STEMI 和 MV-CAD 患者的预后比单支 CAD 患者的预后更差。这些患者的最佳血运重建策略尚不确定。方法通过电子搜索确定了 2001 年至 2015 年间发表的关于接受直接 PCI 的 STEMI 患者 MV-CAD 血运重建策略的研究。对前瞻性和回顾性研究中的 3 种 PCI 策略进行了配对和网络荟萃分析：1) 仅梗塞相关动脉 (IRA) PCI； 2) 单程序MV-PCI； 3) 分阶段MV-PCI。提取了有关研究设计、纳入和排除标准以及临床结果的信息。感兴趣的结果是短期和长期死亡率。 结果 分析中纳入了 32 项研究（13 项前瞻性研究和 19 项回顾性研究），涉及 54,148 名患者（仅 IRA PCI [n = 42,112]、单次手术 MV-PCI [n = 8,138] 和分期 MV-PCI [n = 3,898]）。配对荟萃分析显示，与仅 IRA PCI 和单期 MV-PCI 相比，分期 MV-PCI 与较低的短期和长期死亡率相关，而与单期 MV-PCI 相比，仅 IRA PCI 与较低的死亡率相关。在网络分析中，分期 MV-PCI 也与生存率的提高一致。 结论 目前的系统评价和荟萃分析支持以下假设：对于接受直接 PCI 的 STEMI 的 MV-CAD 患者，分期多支血管血运重建策略可能会改善早期和晚期生存。 (C) 2016 年，美国心脏病学会基金会。
OBJECTIVES The authors conducted a systematic pairwise and network meta-analysis to assess optimal treatment strategies in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MV-CAD) undergoing primary percutaneous coronary intervention (PCI).BACKGROUND Patients with STEMI and MV-CAD have a worse prognosis than those with single-vessel CAD. The optimal revascularization strategy for these patients is uncertain.METHODS Studies of revascularization strategies for MV-CAD in STEMI patients undergoing primary PCI published between 2001 and 2015 were identified using an electronic search. Pairwise and network meta-analyses were performed for 3 PCI strategies in prospective and retrospective studies: 1) infarct-related artery (IRA)-only PCI; 2) single procedure MV-PCI; and 3) staged MV-PCI. Information on study design, inclusion and exclusion criteria, and clinical outcomes was extracted. The outcomes of interest were short-term and long-term mortality.RESULTS Thirty-two studies (13 prospective and 19 retrospective) with 54,148 patients (IRA-only PCI [n = 42,112], single procedure MV-PCI [n = 8,138], and staged MV-PCI [n = 3,898]) were included in the analysis. Pairwise meta-analyses showed that staged MV-PCI was associated with lower short-term and long-term mortality compared with both IRA-only PCI and single stage MV-PCI, whereas IRA-only PCI was associated with lower mortality compared with single stage MV-PCI. Staged MV-PCI was also associated consistently with improved survival in network analyses.CONCLUSIONS The present systematic review and meta-analysis supports the hypothesis that in patients with MV-CAD presenting with STEMI undergoing primary PCI, a staged multivessel revascularization strategy may improve early and late survival. (C) 2016 by the American College of Cardiology Foundation.