急性冠脉综合征患者介入治疗的最佳时机是什么?

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随机对照试验的荟萃分析结果

随机对照试验的荟萃分析结果

背景

建议常规介入治疗用于治疗非 ST 段抬高型急性冠脉综合征(NSTE-ACS)患者。然而,尚未很明确的确定介入治疗的最佳时机。各个临床试验的把握度不足以检测出死亡率收益;因此我们进行了一项荟萃分析,评估时机对死亡率的影响。

方法
我们通过搜索 MEDLINE、Cochrane 对照试验中心登记和 Embase,识别出了在患有 NSTE-ACS 的患者中比较早期介入治疗与延迟介入治疗的随机分配对照试验。我们纳入了报告在入院随机分配后至少 30 天全因死亡率且试验研究者同意合作(即,提供各名患者的数据或标准化表格数据)的试验。我们使用随机效应模型汇总了风险比(HR)。该荟萃分析在 PROSPERO 登记(CRD42015018988)。

结果

我们纳入 8 个试验(n = 5324 名患者),中位随访时间为 180 天(IQR,180-360 天)。整体而言,早期介入组的死亡率与延迟介入组的死亡率相比,没有显著性降低(HR 0.81,95% CI,0.64-1.03;p = 0.0879)。在预先定义的对高风险患者的分析中,我们发现在如下患者中使用早期介入治疗死亡率更低:基线时心脏生物标志物水平升高(HR 0.761,95% CI 0.581-0.996)、糖尿病(0.67、0.45-0.99)、GRACE 风险评分大于 140(0.70,0.52-0.95)和年龄大于 75 岁(0.65,0.46-0.93),但是对相互作用的检测未得出结论。
解读

在所有 NSTE-ACS 患者中,早期介入治疗与延迟介入治疗相比,未降低死亡率。然而,早期介入治疗可能会降低高风险患者的死亡率。

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