ST段抬高心肌梗死行介入治疗患者冠脉相对于静脉使用Ⅱb/Ⅲa受体拮抗剂临床效果的Meta分析

尹建; 徐强; 司良毅

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ST段抬高心肌梗死行介入治疗患者冠脉相对于静脉使用Ⅱb/Ⅲa受体拮抗剂临床效果的Meta分析

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- ST段抬高心肌梗死行介入治疗患者冠脉相对于静脉使用Ⅱb/Ⅲa受体拮抗剂临床效果的Meta分析
- Clinical efficacy of intracoronary versus intravenous administration of platelet glycoprotein IIb/IIIa receptor antagonists in primary percutaneous coronary intervention of ST-segment elevation myocardial infarction: a systematic review
- 陆军军医大学学报 2012年34卷第10期页码：974-979
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  中图分类号： R181.23;R542.22;R973.2
- 纸质出版：2012
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尹建,徐强,司良毅.ST段抬高心肌梗死行介入治疗患者冠脉相对于静脉使用Ⅱb/Ⅲa受体拮抗剂临床效果的Meta分析[J].陆军军医大学学报(原第三军医大学学报),2012,34(10):974-979.

　Yin Jian,Xu Qiang,Si Liangyi.Clinical efficacy of intracoronary versus intravenous administration of platelet glycoprotein IIb/IIIa receptor antagonists in primary percutaneous coronary intervention of ST-segment elevation myocardial infarction: a systematic review[J].J Amry Med Univ (J Third Mil Med Univ),2012,34(10):974-979.
尹建,徐强,司良毅.ST段抬高心肌梗死行介入治疗患者冠脉相对于静脉使用Ⅱb/Ⅲa受体拮抗剂临床效果的Meta分析[J].陆军军医大学学报(原第三军医大学学报),2012,34(10):974-979. DOI：

　Yin Jian,Xu Qiang,Si Liangyi.Clinical efficacy of intracoronary versus intravenous administration of platelet glycoprotein IIb/IIIa receptor antagonists in primary percutaneous coronary intervention of ST-segment elevation myocardial infarction: a systematic review[J].J Amry Med Univ (J Third Mil Med Univ),2012,34(10):974-979. DOI：

摘要

目的系统评价ST段抬高心肌梗死（ST segment elevation myocardial infarction

STEMI）行经皮冠状动脉介入治疗（percutaneous coronary intervention

PCI）患者，冠脉较静脉使用血小板糖蛋白（platelet glycoprotein，GP）Ⅱb/Ⅲa受体拮抗剂的有效性及安全性。方法 2011年9月至10月，计算机检索美国国立生物医学信息中心PubMed数据库、Cochrane 图书馆临床对照试验数据库、荷兰医学文摘embase数据库、中国生物医学文献数据库（CBM）和中国期刊全文数据库（CJFD）。同时检索相关网站，尽量获取会议摘要及灰色文献。使用RevMan 5.1软件对纳入研究进行Meta分析。结果共纳入11篇文献，总计1 569例患者。Meta分析结果示：冠脉较静脉使用GP Ⅱb/Ⅲa受体拮抗剂能显著改善STEMI患者术后心肌梗死溶栓试验（TIMI）3级血流（RR=1.08，95%CI为1.04~1.13，P0.01），TIMI心肌组织灌注分级（TMPG）3级血流（RR=1.37，95%CI为1.16~1.63，P0.01），左室射血分数（MD=0.04，95%CI为0.02~0.06，P0.01），降低主要不良心脏事件（MACE）发生率（RR=0.48，95%CI为0.34~0.69，P0.01），同时不增加主要出血并发症（RR=1.04，95%CI为0.55~1.95，P=0.90）。阿昔单抗在此基础上能进一步降低1个月时死亡率（RR=0.45，95%CI为0.21~0.99，P=0.05）。结论冠脉较静脉途径使用GP Ⅱb/Ⅲa受体拮抗剂能改善STEMI行PCI治疗患者术后罪犯血管再通、心肌灌注及左心室功能恢复，降低主要不良心脏事件发生率，同时不增加主要出血并发症。

Abstract

Objective To evaluate the efficiency and safety of intracoronary versus intravenous administration of platelet glycoprotein IIb/IIIa (GP IIb/IIIa) receptor antagonists in patients with ST-segment elevation myocardial infarction (STEMI) received percutaneous coronary intervention (PCI). Methods Randomized controlled trials were searched in the following databases including PubMed

Excerpta Medica Database (Embase)

Cochrane library (Issue 2

2011)

Chinese Biomedical Literature Database (CBM) and Chinese Journal Full-text Database (CJFD) from September 2011 to October 2011. Besides

according to the Cochrane Handbook

we searched relative websites for meeting abstracts and grey literatures

and obtained the latest trials through the Google search. Quality assessment and data extraction were conducted by two reviewers independently. Disagreements were resolved through discussion. All data were analyzed using Review Manager 5.1. Results Eleven trials involving 1 569 patients were included in the meta-analysis. The meta-analysis results showed that compared with intravenous administration of GP IIb/IIIa receptor antagonists

intracoronary administration could significantly improve the postoperative thrombolysis in myocardial infarction (TIMI) flow grade 3 (RR=1.08

95%CI: 1.04-1.13

P0.01)

TIMI myocardial perfusion grade (TMPG) flow grade 3 (RR=1.37

95%CI: 1.16-1.63

P0.01)

one-month major adverse cardiac events (RR=0.48

95%CI: 0.34-0.69

P0.01) and the recovery of left ventricular ejection fraction (MD=0.04

95%CI: 0.02-0.06

P0.01) without increase of the incidence of TIMI defined major bleeding (RR=1.04

95%CI: 0.55-1.95

P=0.90) in patients with STEMI received PCI. Besides

abciximab was associated with a significant reduction in one-month mortality (RR=0.45

95%CI: 0.21-0.99

P=0.05). Conclusion Compared with intravenous administration of GP IIb/IIIa receptor antagonists

intracoronary administration can improve the postoperative TIMI flow grade

postoperative myocardial reperfusion

one-month major adverse cardiac events and recovery of left ventricular ejection fraction without increase of the incidence of bleeding in patients with STEMI received PCI.

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