负荷他汀类药物对急性ST段抬高型心肌梗死患者介入治疗术后疗效的Meta分析

安杰; 温盛燕; 佘强

doi:10.16016/j.1000-5404.201707018

您当前的位置：

首页 >

文章列表页 >

负荷他汀类药物对急性ST段抬高型心肌梗死患者介入治疗术后疗效的Meta分析

临床医学 | 更新时间：2026-01-09

- 负荷他汀类药物对急性ST段抬高型心肌梗死患者介入治疗术后疗效的Meta分析
- Effect of high-dose statins in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention: a meta-analysis and systematic review
- 第三军医大学学报 2017年39卷第23期页码：2316-2322
- 作者机构：
  
  400010 重庆，重庆医科大学附属第二医院心血管内科
- 作者简介：
  
  [佘强，E-mail：qshe98@hotmail.com SHE Qiang, E-mail: qshe98@hotmail.com
- 基金信息：
- DOI：10.16016/j.1000-5404.201707018
  中图分类号： R181.23;R542.22;R972.6
- 收稿：2017-07-01，
  
  修回：2017-08-29，
  
  纸质出版：2017-12-15
- 稿件说明：
移动端阅览
安杰, 温盛燕, 佘强. 负荷他汀类药物对急性ST段抬高型心肌梗死患者介入治疗术后疗效的Meta分析[J]. 第三军医大学学报, 2017,39(23):2316-2322.

Jie AN, Shengyan WEN, Qiang SHE. Effect of high-dose statins in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention: a meta-analysis and systematic review[J]. Journal of Third Military Medical University, 2017, 39(23): 2316-2322.
安杰, 温盛燕, 佘强. 负荷他汀类药物对急性ST段抬高型心肌梗死患者介入治疗术后疗效的Meta分析[J]. 第三军医大学学报, 2017,39(23):2316-2322. DOI： 10.16016/j.1000-5404.201707018.

Jie AN, Shengyan WEN, Qiang SHE. Effect of high-dose statins in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention: a meta-analysis and systematic review[J]. Journal of Third Military Medical University, 2017, 39(23): 2316-2322. DOI： 10.16016/j.1000-5404.201707018.

摘要

目的

评价负荷他汀类药物对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction，STEMI)患者经皮冠状动脉介入(percutaneous coronary intervention，PCI)治疗术后的疗效。

方法

计算机检索PubMed、EMBASE、Cochrane Library等数据库，收集数据库建库至2017年3月的随机对照试验研究。两位评价者独立评价纳入研究质量、提取资料并交叉核对。采用Rev Man 5.3软件进行Meta分析。

结果

共纳入11项RCT研究，合计1 419例患者。PCI术前负荷他汀类药物对心肌梗死溶栓治疗(thrombolysis in myocardial infarction，TIMI)后血流的改善显著高于对照组(

=1.09，95%

：1.05~1.13，

0.01)。负荷组30 d主要心血管不良事件(major adverse cardiovascular events，MACEs)的发生率低于对照组(

=0.50，95%

：0.32~0.79，

0.01)。亚组分析结果显示：PCI术前单次负荷他汀治疗后30

MACEs的发生率(

=0.47，95%

：0.22~1.01，

=0.05)。短期负荷他汀治疗后30

MACEs的发生率(

=0.52，95%

：0.30~0.91，

0.05)。

结论

STEMI患者负荷他汀治疗能改善PCI术后心肌血流灌注，能降低30 dMACEs的发生率。

Abstract

Objective

To determine the effect of high-dose statins in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI).

Methods

PubMed

EMBASE

Cochrane Library

CNKI and SinoMed were searched for randomized controlled trials (RCTs) concerning above subjects and treatments published up to March

2017. Two reviewers independently evaluated the quality of the included studies. Meta-analysis was performed by RevMan 5.3 software.

Results

Eleven RCTs involving 1 419 patients were included. The results showed that high-dose statins significantly improved the final thrombolysis in m

yocardial infarction (TIMI) flow grade after PCI (

=1.09

95%

=1.05~1.13

0.01) and reduced the incidence of major adverse cardiovascular events (MACEs) at 30-day follow-up (

=0.50

95%

=0.32~0.79

0.01). Subgroup analysis indicated that only short-term high-dose statin (

=0.52

95%

=0.30~0.91

0.05) but not single high-dose statin treatment (

=0.47

95%

=0.22~1.01

=0.05) showed priority in decreasing the occurrence of MACEs.

Conclusions

High-dose statins can significantly improve microvascular myocardial perfusion and decrease the incidence of 30-day MACEs in STEMI patients after PCI.

关键词

Keywords

references

YEH R W, SIDNEY S, CHANDRA M, et al . Population trends in t he incidence and outcomes of acute myocardial infarction[J ] . N Engl J Med, 2010, 362(23):2155-2165. DOI:10.1056/NEJMoa0908610.

O'GARA P T, KUSHNER F G, ASCHEIM D D, et al . 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J ] . J Am Coll Cardiol, 2013, 61(4):485-510. DOI: 10.1016/j.jacc.2012.11.018.

BERENT R, BERENT T, KARKUTLI E, et al . Influence of high-dose highly efficient statins on short-term mortality in patients undergoing percutaneous coronary intervention with stenting for acute coronary syndromes[J ] . Am J Cardiol, 2014, 114(7):1128-1129. DOI:10.1016/j.amjcard.2014.07.003.

KIM J W, YUN K H, KIM E K, et al . Effect of high dose rosuvastatin loading before primary percutaneous coronary intervention on infarct size in patients with ST-segment elevation myocardial infarction[J ] . Korean Circ J, 2014, 44(2):76-81.DOI:10.4070/kcj.2014.44.2.76

POST S, POST M C, VAN DEN BRANDEN B J, et al . Early statin treatment prior to primary PCI for acute myocardial infarction: REPERATOR, a randomized placebo-controlled pilot trial[J ] . Catheter Cardiovasc Interv, 2012, 80(5): 756-765. DOI:10.1002/ccd.23449.

KIM J S, KIM J, CHOI D, et al . Efficacy of high-dose atorvastatin loading before primary percutaneous coronary intervention in ST-segment elevation myocardial infarction: the STATIN STEMI trial[J ] . JACC Cardiovasc Interv, 2010, 3(3):332-339.DOI:10.1016/j.jcin.2009.11.021.

王兵. 大剂量阿托伐他汀在急性心肌梗死患者急诊冠状动脉介入治疗围手术期的应用研究[D]. 苏州: 苏州大学, 2013.

WANG B.The application research of high-dose atorvastatin to acute myocardial infarction patients during percutaneous coronary artery interventional therapy: a randomized controlled clinical research about Chinese people[D]. Suzhou: Soochow University, 2013.

KO Y G, WON H, SHIN D H, et al . Efficacy of early intensive rosuvastatin therapy in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (ROSEMARY Study)[J ] . Am J Cardiol, 2014, 114(1):29-35. DOI:10.1016/j.amjcard.2014.03.059.

葛广豪, 龚勇, 马江伟, 等.不同负荷剂量他汀类药物对老年急性心肌梗死直接介入治疗术后心肌细胞的影响[J].中华老年心脑血管病杂志, 2016, 18(9): 899-904. DOI:10.3969/j.issn.1009-0126.2016.09.002.

GE G H, GONG Y, MA J W, et al . Effect of different statin doses on myocardial cells in elderly acute myocardial infa rction patients after primary PCI[J ] .Chin J Geriatr Heart Brain Vessel Dis, 2016, (9):899-904.DOI:10.3969/j.issn.1009-0126.2016.09.002.

卢青, 丁世芳, 陈志楠, 等.瑞舒伐他汀不同预处理对急性ST段抬高型心肌梗死后患者冠状动脉介入治疗后心肌再灌注及相关因素的影响[J].中国心脏起搏与心电生理杂志, 2016, 30(6): 517-521.DOI: 10.13333/j.cnki.cjcpe.2016.06.012.

LU Q, DING S F, CHEN Z N, et al . Impact of different pre-treatment of rosuvastatin on the level of myocardial reperfusion and relevant factors in patients suffered from ST-segment elevation myocardial infarction underwent primary percutaneous coronary intervention[J ] . Chin J Cardiac Pacing Electrophysiol, 2016, (6):517-521.DOI:10.13333/j.cnki.cjcpe.2016.06.012.

中华医学会心血管病学分会, 中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志2010, 38(8): 675-690.

Branch of Cardiology of CMA, Editorial Committee of Chin J Cardiol. Diagnosis and treatment of acute ST-segment elevation myocardial infarction[J]. Chin J Cardiol, 2010, 38(8):675-690.

任美欣, 严松彪, 陈晖.直接经皮冠状动脉介入治疗前即刻应用大剂量阿托伐他汀对心肌再灌注损伤和心功能的影响[J].中国介入心脏病学杂志, 2012, 20(6) : 317-320. DOI:10.3936/j.issn.1004-8812.2012.06.005.

REN M X, YAN S B, CHEN H. The effect of loading dose atorvastatin administration shortly before P-PCI on myocardial reperfusion and cardiac function[J]. Chin J Intervent Cardiol, 2012, (6):317-320.DOI:10.3936/j.issn.1004-8812.2012.06.005.

许敏, 郭金成, 王国忠, 等.急诊冠状动脉介入术强化阿托伐他汀治疗的临床疗效[J].临床心血管病杂志, 2013, 29(1) : 17-20. DOI:10.13201/j.issn.1001-1439.2013.01.020.

XU M, GUO J C, WANG G Z et al . Intensive atorvastatin treatment on primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction[J ] . J Clinic Cardiol, 2013, (1):17-20.DOI:10.13201/j.issn.1001-1439.2013.01.020.

汤玮. 急性ST段抬高型心肌梗死急诊PCI术前负荷剂量阿托伐他汀治疗长期疗效观察[D]. 石家庄: 河北医科大学, 2013.

TANG W, LIU X L. Long-term clinical efficacy of loading-dose atorvastatin before emergengcy percutaneous coronary intervention in patients with ST elevation myocardial infarction[D]. Shijiazhuang: Hebei Medical University, 2013.

戴敬, 吕树铮, 宋现涛, 等.围术期阿托伐他汀序贯治疗对急性ST段抬高性心肌梗死患者组织灌注和临床预后的探讨[J].心肺血管病杂志, 2015 (1) : 7-11. DOI:10.3969/j.issn.1007-5062.2015.01.002.

DAI J, LV S Z, SONG X T, et al . Perioperative atorvastatin sequential therapy of acute ST-elevation myocardial infarction patients improves myocardial perfusion and clinical prognosis[J ] . J Cardiovasc Pulmon Dis, 2015(1):7-11. DOI:10.3969/j.issn.1007-5062.2015.01.002.

王学斌. 大剂量阿托伐他汀对急性心肌梗死患者预后的影响研究[D]. 苏州: 苏州大学, 2015.

WANG X B. High dose atorvastatin therapy in acute myocardial infarction[D]. Suzhou: Soochow University, 2015.

LI X D, YANG Y J, HAO Y C, et al . Effect of pre-procedural statin therapy on myocardial no-reflow following percutaneous coronary intervention: a meta analysis[J ] . Chin Med J, 2013, 126(9):1755-1760.DOI:10.3760/cma.j.issn.0366-6999.20122700.

LYU T, ZHAO Y, ZHANG T, et al . Effect of statin pretreatment on myocardial perfusion in patients undergoing primary percutaneous coronary intervention: a systematic review and meta-analysis[J ] . Clin Cardiol, 2013, 36(9):E17-24.DOI:10.1002/clc.22169.

BEKKERS S C, YAZDANI S K, VIRMANI R, et al .Microvascular obstruction: underlying pathophysiology and clinical diagnosis[J ] . J Am Coll Cardiol, 2010, 55(16):1649-1660. DOI:10.1016/j.jacc.2009.12.037.

JAFFE R, CHARRON T, PULEY G, et al . Microvascular obstruction and the no-reflow phenomenon after percutaneous coronary intervention[J ] . Circulation, 2008, 117(24):3152-3156. DOI:10.1161/CIRCULATIONAHA.107.742312.

UNNI S K, QUEK R G, BISKUPIAK J, et al . Assessment of statin therapy, LDL-C levels, and cardiovascular events among high-risk patients in the United States[J ] . J Clin Lipidol, 2016, 10(1):63-71.e1-3. DOI:10.1016/j.jacl.2015.09.008.

LIU H L, YANG Y, YANG S L, et al . Administration of a loading dose of atorvastatin before percutaneous coronary intervention prevents inflammation and reduces myocardial injury in STEMI patients: a randomized clinical study[J ] . Clin Ther, 2013, 35(3):261-272. DOI:10.1016/j.clinthera.2013.01.009.

PATTI G, PASCERI V, COLONNA G, et al . Atorvastatin pretreatment improves outcomes in patients with acute coronary syndromes undergoing early percutaneous coronary intervention: results of the ARMYDA-ACS randomized trial[J ] . J Am Coll Cardiol, 2007, 49(12):1272-1278.DOI:10.1016/j.jacc.2007.02.025.

DI S G, PATTI G, PASCERI V, et al . Efficacy of atorvastatin reload in patients on chronic statin therapy undergoing percutaneous coronary intervention: results of the ARMYDA-RECAPTURE (Atorvastatin for Reduction of Myocardial Damage During Angioplasty) Randomized Trial[J ] . J Am Coll Cardiol, 2009, 54(6):558-565.DOI:10.1016/j.jacc.2009.05.028.

WANG L, PENG P, ZHANG O, et al . High- dose statin pretreatment decreases periprocedural myocardial infarction and cardiovascular events in patients undergoing elective percutaneous coronary intervention: a meta-analysis of twenty-four randomized controlled trials[J ] . PLoS One, 2014, 9(12):e113352. DOI:10.1371/journal.pone.0113352.

CATAPANO A L, GRAHAM I, DE BACKER G, et al . 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias[J ] . Kardiol Pol, 2016, 74(11):1234-1318.DOI:10.5603/KP.2016.0157.

HAHN J Y, KIM H J, CHOI Y J, et al . Effects of atorvastatin pretreatment on infarct size in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention[J ] . Am Heart J, 2011, 162(6):1026-1033.DOI:10.1016/j.ahj.2011.08.011.

SUN Y, QI G, GAO Y, et al . Effect of different loading doses of atorvastatin on percutaneous coronary intervention for acute coronary syndromes[J ] . Can J Cardiol, 2010, 26(9):481-485.

LEE C H, LEE S H, PARK J S, et al . Impact of statin usage patterns on outcomes after percutaneous coronary intervention in acute myocardial infarction: Korea Working Group on Myocardial Infarction registry (KorMI) study[J ] . J Geriatr Cardiol, 2014, 11(2):93-99. DOI:10.3969/j.issn.1671-5411.2014.02.010.

EMBERSON J R, KEARNEY P M, BLACKWELLL, et al . Lack of effect of lowering LDL cholesterol on cancer: meta-analysis of individual data from 175, 000 people in 27 randomised trials of statin therapy[J ] . PLoS One, 2012, 7(1):e29849.DOI:10.1371/journal.pone.0029849.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

不同剂量瑞舒伐他汀对中国人颈动脉粥样硬化斑块影响的Meta分析

基于系统评价和Meta分析的糖尿病足溃疡患者截肢风险预测模型的开发和验证

Del Nido 液对成人体外循环心脏手术心肌保护的影响：Meta分析

新型冠状病毒肺炎患者转氨酶水平的Meta分析

18F-FDG PET/CT全身显像对原发不明转移瘤患者原发灶检出价值的Meta分析