经皮冠状动脉介入治疗术前负荷剂量他汀类药物减少心血管事件效果的Meta分析

摘要

目的 研究经皮冠状动脉介入治疗(PCI)术前负荷剂量他汀类药物治疗减少心血管事件的有效性.方法 检索Medline,Pubmed,荷兰医学文摘数据库(Embase)中关于PCI术前给予负荷剂量他汀与安慰剂对比的前瞻性随机对照试验,采用Meta分析评估PCI术前给予负荷剂量他汀类药物对围术期心肌梗死(pMI)发生率及终点事件,包括死亡、白发心肌梗死和靶血管血运重建的影响.结果 最终纳入14篇文献,共3 146例患者,术前给予负荷剂量他汀类药物(观察组)1 591例、术前未给予负荷剂量他汀类药物(对照组)1 555例.观察组pMI发生率和随访联合终点事件发生率明显低于对照组[比值比(OR):0.44,95％置信区间(CI):0.35～0.56,P＜0.000 01;OR:0.59,95％ CI:0.38 ～0.92,P=0.02).分别对稳定型心绞痛患者和非ST段抬高型急性冠状动脉综合征(NSTE-ACS)患者进行亚组分析,二者观察组pMI发生率均明显低于对照组,差异有统计学意义(OR:0.33,95％ CI:0.22 ～0.50,P＜0.000 01;OR:0.32,95％ CI:0.19 ～0.53,P＜0.000 1);稳定型心绞痛患者2组间终点事件发生率差异无统计学意义(OR:0.92,95％ CI:0.53 ～ 1.61;P =0.78),NSTE-ACS患者观察组终点事件发生率明显低于对照组(OR:0.18,95％ CI:0.07～0.47;P=0.000 5).结论 NSTE-ACS患者PCI术前给予负荷剂量他汀类药物可以明显降低pMI和心血管不良事件发生率.%Objective To assess the effect of statin loading before percutaneous coronary intervention (PCI) on reducing the incidences of cardiovascular events through Meta-analysis.Methods The randomized controlled trials about statin loading/placebo before PCI were retrieved in Medline,Pubmed and Excerpta medica database (Embase).Meta analysis was used to assess the influences of statin loading before PCI on incidences of periprocedural myocardial infarction (pMI) and endpoint events including death,spontaneous myocardial infarction and target vessel revascularization.Results Totally 14 literatnres including 3 146 patients were enrolled.Among 3 146 cases,1 591 patients were given loading dose of statin before PCI (observation group) and 1 555 patients were not given statin loading before PCI (control group).The incidences of pMI and combined endpoint events in observation group were significantly lower than those in control group (OR:0.44,95％ CI:O.35-0.56,P ＜ 0.000 01;OR:0.59,95％ CI:0.38-0.92,P =0.02).The incidence of pMI in observation group was significantly lower than that in control group in both patients with stable angina pectoris (OR:0.33,95％ CI:0.22-0.50,P ＜0.000 01)and patients with non-ST elevation acute coronary syndrome (NSTE-ACS) (OR:0.32,95％ CI:0.19-0.53,P ＜0.000 1);in patients with stable angina pectoris,the incidence of combined endpoint events was not significantly different between groups (OR:0.92,95％ CI:0.53-1.61,P=0.78),while in patients with NSTE-ACS,the incidence of combined endpoint events in observation group was significantly lower than that in control group (OR:0.18,95 ％ CI:0.07-0.47;P =0.000 5).Conclusions Statin loading before PCI can significantly reduce the incidences of pMI and short-term cardiovascular events.