主动脉内球囊反搏对接受不同血管重建急性心肌梗死患者预后影响的荟萃分析被引量：13

Efficacy of intra-aortic balloon counterpulsation in patients with acute myocardial infarctionaccording to the type of revascularization： a meta-analysis

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摘要目的探讨主动脉内球囊反搏（IABP）对接受不同血管重建治疗急性心肌梗死（AMI）患者预后的影响。方法联机检索Medline、Embase和Cochrane数据库，收集1970年1月至2015年5月期间发表的IABP治疗AMI的临床随机对照试验文献，按纳入与排除标准选择文献。对照组的治疗采用血管重建（溶栓、经皮冠状动脉介入治疗或冠状动脉旁路移植术），试验组在对照组基础上使用IABP。采用RevMan5．0软件对文献进行荟萃分析。结果（1）共纳入临床随机对照试验文献11篇，入选患者2225例，其中试验组1102例，对照组1123例。（2）试验组与对照组之间的住院或30d病死率差异无统计学意义（OR：0．84，95％cI0．65～1．09，P=0．20）。（3）在接受溶栓治疗的患者中，试验组与对照组之间的住院或30d病死率差异无统计学意义（OR=0．64，95％C10．25～1．61，P=0．34）；在接受经皮冠状动脉介入治疗的患者中，试验组与对照组之间的住院或30d病死率差异无统计学意义（OR=0．89，95％C10．68～1．18，P=0．42）；在接受冠状动脉旁路移植术的患者中，试验组与对照组之间的住院或30d病死率差异无统计学意义（OR=0．46，95％C10．13～1．63，P=0．23）。（4）在经皮冠状动脉介入治疗前使用IABP的患者中，试验组与对照组之间的住院或30d病死率差异无统计学意义（OR=0．47，95％C10．22～1．00，P=0．05）；在经皮冠状动脉介入治疗后使用IABP的患者中，试验组与对照组之间的住院或30d病死率差异也无统计学意义（OR=1．33，95％C10．63～2．79，P：0．45）。结论IABP不降低接受血管重建治疗AMI患者的住院或30d病死率。在经皮冠状动脉介入治疗前使用IABP可能会降低AMI患者的住院或30d病死率，但需要大样本临床随机对照试验的证实。 Objective To evaluate the effects of intra-aortic balloon counterpulsation （IABP） on mortality in patients with acute myocardial infarction according to the type of revascularization. Methods Recruited randomized controlled trials of IABP compared with no-IABP controls in acute myocardial infarction patients from January 1970 to May 2015 were searched from Medline, Embase and Cochrane Libra, according to inclusion criteria and exclusion criteria. These data were analyzed using the methods recommended by the Cochrane Collaboration＇s software RevMan 5.0. Revascularization included thrombolytic therapy, percutaneous coronary intervention （PCI）, or coronary artery bypass grafting. Results （ 1 ） Eleven randomized controlled trials were enrolled for analysis with 1 102 patients in IABP group, 1 123 in no-IABP control group. （2） Compared with no-IABP control group, IABP could not significantly decrease the in-hospital or 30 day mortality （ OR =0.84,95% CI O. 65 - 1.09,P =0. 20）. （3） Compared with no- IABP control group, IABP could not significantly decrease the in-hospital or 30 day mortality in thrombolytic patients（ OR =0. 64,95% CI O. 25 - 1.61 ,P = 0. 34）, in PCI patients （ OR = 0. 89,95% CI O. 68 - 1. 18, P = 0.42） , and in coronary artery bypass grafting patients （ OR = 0.46,95% CI O. 13 - 1.63, P = 0. 23 ）.（4） The difference reached borderline signiicance between no-IABP control group and IABP group in patients using IABP before PCI（ OR =0. 47,95% CI O. 22 - 1.00 ,P =0. 05）, but not in case of after PCI（ OR = 1.33, 95% C10. 63 - 2. 79,P = 0. 45 ）. Conclusions IABP does not decrease the in-hospital or 30 day mortality of acute myocardial infarction patients who received thrombolytic therapy, PCI, or coronary artery bypass grafting. But IABP might decreases the in-hospital or 30 day mortality in patients when used before PCI.

作者高志伟黄英姿赵红梅孙虹

机构地区南京医科大学附属淮安第一医院急诊科东南大学附属中大医院重症医学科

出处《中华心血管病杂志》 CAS CSCD 北大核心 2016年第7期588-593,共6页 Chinese Journal of Cardiology

关键词心肌梗死主动脉内球囊反搏死亡率 Myocardial infarction Intra-aortic balloon counterpulsation Mortality

分类号 R542.22 [医药卫生—心血管疾病]

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参考文献28

1Hochman JS, Sleeper LA, Webb JG, et al. Early revascularization and long-term survival in cardiogenie shock complicating acute myocardial infarction [ J ]. JAMA, 2006,295 (21) :2511-2515.
2张贤锐,苏立,陈少杰,张晓歌,殷跃辉.主动脉球囊反搏辅助治疗急性心肌梗死患者疗效评价[J].中华心血管病杂志,2013,41(5):432-437. 被引量：25
3O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines [J]. Circulation, 2013,127 (4) : e362-425.
4Stegman BM, Newby LK, Hochman JS, et al. Post-myocardial infarction cardiogenic shock is a systemic illness in need of systemic treatment: is therapeutic hypothcrmia one possibility? [J]. J Am Coil Cardiol, 2012,59(7) :644-647.
5Unverzagt S, Buerke M, de Waha A, et al. Intra-aortic balloon pump counterpulsation ( IABP ) for myocardial infarction complicated by cardiogenic shock [J]. Cochrane Database Syst Rev, 2015,3 :CD007398.
6Ahmad Y, Sen S, Shun-Shin M J, et al. Intra-aortic Balloon Pump Therapy for Acute Myocardial Infarction: A Meta-analysis [J]. JAMA Intern Med, 2015, 175 (6):931-939.
7Lee JM, Park J, Kang J, et al. The efficacy and safety of mechanical hernodynamie support in patients undergoing high-risk percutaneous coronary intervention with or without eardiogenic shock: Bayesian approach network meta-analysis of 13 randomized controlled trials [ J ]. int J Cardiol, 2015,184 : 36-46.
8Thiele H, Zeymer U, Neumann FJ, et al. Intraaortic balloon support for myocardial infarction with cardiogenie shock [J]. N Engl J Med, 2012, 367 ( 14 ) : 1287-1296.
9Romeo F, Acconcia MC, Sergi D, et al. The outcome of inTraaortic balloon pump support in acute myocardial inFare/ion complicated by cardiogenie shock according to the type of revascularization: a comprehensive meta-analysis [ J ]. Am Heart J, 2013,165(5) :679-692.
10Byar DP, Simon RM, Friedewald WT, et al. Randomized clinical trials. Perspectives on some recent ideas [ J ]. N Engl J Med, 1976,295(2) :74-80.

二级参考文献22

1Kantrowitz A, Tjonneland S, Freed PS, et al. Initial clinical experience with intraaortic balloon pumping in cardiogenic shock. JAMA, 1968, 203:113-118.
2Brodie BR, Stuckey TD, Hansen C, et al. Intra-aortic balloon counterpulsation before primary percutaneous transluminal coronary angioplasty reduces catheterization laboratory events in higb-risk patients with acute myocardial infarction. Am J Cardiol, 1999,84 : 18-23.
3Cohen M, Dawson MS, Kopistansky C, et al. Sex and other predictors of intra-aortic balloon counterpulsation-relatcd complications: prospective study of 1119 consecutive patients. Am Heart J,2000 ,139 :282-287.
4Briguori C, Sarais C, Pagnotta P, et al. Elective versus provisional intra-aortic balloon pumping in high-risk percutaneous transluminal coronary angioplasty. Am Heart J, 2003,145 : 700- 707.
5Vijayalakshmi K, Kunadian B, Whittaker VJ, et al. Intra-aortic counterpulsation does not improve coronary flow early after PCI in a high-risk group of patients : observations from a randomized trial to explore its mode of action. J Invasive Cardiol, 2007,19: 339- 346.
6Perera D, Stables R, Thomas M, et al. Elective intra-aortic balloon counterpulsation during high-risk percutaneous coronary intervention: a randomized controlled trial. JAMA, 2010, 304: 867 -874.
7Sjauw KD, Engstrm AE, Vis MM, et al. A systematic review and meta-analysis of intra-aortic balloon pump therapy in ST-elevation myocardial infarction: should we change the guidelines?. Eur Heart J ,2009,30:459468.
8Unverzagt S, Machemer MT, Solms A, et al. Intra-aortic balloon pump counterpulsation ( IABP ) for myocardial infarction complicated by cardiogenic shock. Cochrane Database Syst Rev, 2011,6 : CD007398.
9Bahekar A, Singh M, Singh S, et al. Cardiovascular outcomes using intra-aortic balloon pump in high-risk acute myocardial infarction with or without cardiogenic shock: a meta-analysis. Cardiovasc Pharnmcol Ther,2012,17:44-56.
10O'Rourke MF, Norris RM, Campbell TJ, et al. Randomized controlled trial of intraaortic balloon counterpulsation in early myocardial infarction with acute heart failure. Am J Cardiol, 1981,47:815-820.