冠状动脉侧支循环对行急诊经皮冠状动脉介入治疗的急性心肌梗死患者预后影响的Meta分析
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摘要
目的评价冠状动脉侧支循环(CCC)对行急诊经皮冠状动脉介入治疗(PCI)的急性心肌梗死(AMI)患者预后的影响。方法计算机检索PubMed、EMBase、The Cochrane Library、中国知网、万方数据知识服务平台、维普网等数据库,检索时间为1985年1月—2018年4月,筛选有关CCC对行急诊PCI的AMI患者预后影响的病例对照研究。根据Rentrop分级将患者分为无CCC(Rentrop分级0级)和有CCC(Rentrop分级1~3级)患者,CCC良好(Rentrop分级2~3级)和CCC差(Rentrop分级0~1级)患者,分别比较有/无CCC患者、CCC良好/差患者术后6个月内病死率、术后≥1年病死率、心肌梗死再发率、再次血运重建发生率。采用RevMan 5.3软件进行Meta分析。结果最终纳入15篇文献,包括10 525例患者,其中有CCC患者2 517例,无CCC患者4 092例;CCC良好患者1 010例,CCC差患者2 906例;14篇文献为高质量文献。Meta分析结果显示,有CCC患者术后6个月内病死率[RR=0.40,95%CI(0.25,0.63)]、术后≥1年病死率[RR=0.59,95%CI(0.49,0.72)]低于无CCC患者(P<0.05);CCC良好患者术后6个月内病死率[RR=0.42,95%CI(0.22,0.82)]、术后≥1年病死率[RR=0.64,95%CI(0.49,0.82)]低于CCC差患者(P<0.05)。有/无CCC患者术后心肌梗死再发率[RR=1.15,95%CI(0.56,2.33)]、术后再次血运重建发生率[RR=0.88,95%CI(0.43,1.79)]比较,差异无统计学意义(P>0.05);CCC良好/差患者术后心肌梗死再发率比较,差异无统计学意义[RR=1.01,95%CI(0.77,1.34),P>0.05];1篇文献报道了CCC良好/差患者术后再次血运重建发生率,结果显示,CCC良好/差患者术后30 d及6个月内再次血运重建发生率比较,差异无统计学意义(P>0.05)。结论现有文献证据表明,与无CCC、CCC差相比,有CCC、CCC良好能更有效地降低行急诊PCI的AMI患者术后6个月内及≥1年病死率,但对术后再发心肌梗死及再次血运重建无明显影响。
Objective To evaluate the impact of coronary collateral circulation(CCC)on prognosis in acute myocardial infarction patients treated by emergency PCI. Methods Computer was used to screen case control studies about impact of CCC on prognosis in acute myocardial infarction patients treated by emergency PCI in PubMed,EMBase,The Cochrane Library,CNKI,WANFANG DATA and VIP from January 1985 to April 2018. Patients were divided into A group[without CCC(0-grade Rentrop grading)],B group[with CCC(1-to 3-grade Rentrop grading)],C group[with good CCC(2-to 3-grade Rentrop grading)]and D group[with poor CCC(0-to 1-grade Rentrop grading)]according to Rentrop classification,fatality rate within 6 months and ≥ 1 year after emergency PCI,recurrence rate of myocardial infarction and repeat revascularization ratio were compared between A group and B group,between C group and D group. Results A total of 15 literatures were involved eventually(14 out of the 15 literatures were high-quality),including 10 525 patients,thereinto 4 092 cases in A group,2 517 cases in B group,1 010 cases in C group and 2 906 cases in D group. Meta-analysisresults showed that,fatality rate in B group was statistically significantly lower than A group within 6 months after emergency PCI[RR=0.40,95%CI(0.25,0.63)]and ≥ 1 year after emergency PCI[RR=0.59,95%CI(0.49,0.72)],respectively(P<0.05),meanwhile fatality rate in C group was statistically significantly lower than that in D group within 6 months after emergency PCI[RR=0.42,95%CI(0.22,0.82)]and ≥ 1 year after emergency PCI[RR=0.64,95%CI(0.49,0.82)],respectively(P<0.05).No statistically significant differences of recurrence rate of myocardial infarction[RR=1.15,95%CI(0.56,2.33)]or repeat revascularization ratio[RR=0.88,95%CI(0.43,1.79)]was found between A group and B group(P>0.05),nor was recurrence rate of myocardial infarction between C group and D group[RR=1.01,95%CI(0.77,1.34),P>0.05];only 1 literature reported the repeat revascularization ratio between C group and D group,which showed on statistically significant differences of repeat revascularization ratio 30 days or 6 months after emergency PCI(P>0.05). Conclusion Based on existing literature evidence and compared with non-CCC and poor CCC,CCC and good CCC can more effectively reduce the fatality rate in postoperative patients with acute myocardial infarction within 6 months and ≥ 1 year after emergency PCI,respectively,without significant impact on recurrence of myocardial infarction and repeat revascularization.
Objective To evaluate the impact of coronary collateral circulation(CCC)on prognosis in acute myocardial infarction patients treated by emergency PCI. Methods Computer was used to screen case control studies about impact of CCC on prognosis in acute myocardial infarction patients treated by emergency PCI in PubMed,EMBase,The Cochrane Library,CNKI,WANFANG DATA and VIP from January 1985 to April 2018. Patients were divided into A group[without CCC(0-grade Rentrop grading)],B group[with CCC(1-to 3-grade Rentrop grading)],C group[with good CCC(2-to 3-grade Rentrop grading)]and D group[with poor CCC(0-to 1-grade Rentrop grading)]according to Rentrop classification,fatality rate within 6 months and ≥ 1 year after emergency PCI,recurrence rate of myocardial infarction and repeat revascularization ratio were compared between A group and B group,between C group and D group. Results A total of 15 literatures were involved eventually(14 out of the 15 literatures were high-quality),including 10 525 patients,thereinto 4 092 cases in A group,2 517 cases in B group,1 010 cases in C group and 2 906 cases in D group. Meta-analysisresults showed that,fatality rate in B group was statistically significantly lower than A group within 6 months after emergency PCI[RR=0.40,95%CI(0.25,0.63)]and ≥ 1 year after emergency PCI[RR=0.59,95%CI(0.49,0.72)],respectively(P<0.05),meanwhile fatality rate in C group was statistically significantly lower than that in D group within 6 months after emergency PCI[RR=0.42,95%CI(0.22,0.82)]and ≥ 1 year after emergency PCI[RR=0.64,95%CI(0.49,0.82)],respectively(P<0.05).No statistically significant differences of recurrence rate of myocardial infarction[RR=1.15,95%CI(0.56,2.33)]or repeat revascularization ratio[RR=0.88,95%CI(0.43,1.79)]was found between A group and B group(P>0.05),nor was recurrence rate of myocardial infarction between C group and D group[RR=1.01,95%CI(0.77,1.34),P>0.05];only 1 literature reported the repeat revascularization ratio between C group and D group,which showed on statistically significant differences of repeat revascularization ratio 30 days or 6 months after emergency PCI(P>0.05). Conclusion Based on existing literature evidence and compared with non-CCC and poor CCC,CCC and good CCC can more effectively reduce the fatality rate in postoperative patients with acute myocardial infarction within 6 months and ≥ 1 year after emergency PCI,respectively,without significant impact on recurrence of myocardial infarction and repeat revascularization.
引文
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[3]PRIES A R,BADIMON L,BUGIARDINI R,et al.Coronary vascular regulation,remodelling,and collateralization:mechanisms and clinical implications on behalf of the working group on coronary pathophysiology and microcirculation[J].Eur Heart J,2015,36(45):3134-3146.DOI:10.1093/eurheartj/ehv100.
[4]MEIER P,HEMINGWAY H,LANSKY A J,et al.The impact of the coronary collateral circulation on mortality:a meta-analysis[J].Eur Heart J,2012,33(5):614-621.DOI:10.1093/eurheartj/ehr308.
[5]STANG A.Critical evaluation of the Newcastle-Ottawa scale for the assessment of thequality of nonrandomized studies in meta-analyses[J].Eur J Epidemiol,2010,25(9):603-605.DOI:10.1007/s10654-010-9491-z.
[6]PéREZ-CASTELLANO N,GARCíA E J,ABEYTUA M,et al.Influence of collateral circulation on in-hospital death from anterior acute myocardial infarction[J].J Am Coll Cardiol,1998,31(3):512-518.
[7]ANTONIUCCI D,VALENTI R,MOSCHI G,et al.Relation between preintervention angiographic evidence of coronary collateral circulation and clinical and angiographic outcomes after primary angioplasty or stenting for acute myocardial infarction[J].Am JCardiol,2002,89(2):121-125.
[8]ELSMAN P,VAN'T HOF A W,DE BOER M J,et al.Role of collateral circulation in the acute phase of ST-segment-elevation myocardial infarction treated with primary coronary intervention[J].Eur Heart J,2004,25(10):854-858.
[9]SORAJJA P,GERSH B J,MEHRAN R,et al.Impact of collateral flow on myocardial reperfusion and infarct size in patients undergoing primary angioplasty for acute myocardial infarction[J].Am Heart J,2007,154(2):379-384.
[10]DESCH S,DE WAHA S,EITEL I,et al.Effect of coronary collaterals on long-term prognosis in patients undergoing primary angioplasty for acute ST-elevation myocardial infarction[J].Am J Cardiol,2010,106(5):605-611.DOI:10.1016/j.amjcard.2010.04.010.
[11]WANG B,HAN Y L,LI Y,et al.Coronary collateral circulation:Effects on outcomes of acute anterior myocardial infarction after primary percutaneous coronary intervention[J].J Geriatr Cardiol,2011,8(2):93-98.DOI:10.3724/SP.J.1263.2011.00093.
[12]赖文文.探讨早期侧枝循环对于急性ST段抬高型前壁心肌梗死直接PCI治疗的患者的影响[D].广东:南方医科大学,2013.
[13]RECHCINSKI T,JASINSKA A,PERUGA J Z,et al.Presence of coronary collaterals in ST-elevation myocardial infarction patients does not affect long-term outcome[J].Pol Arch Med Wewn,2013,123(1/2):29-37.
[14]SHEN Y,WU F,PAN C,et al.Clinical relevance of angiographic coronary collaterals during primary coronary intervention for acute ST-elevation myocardial infarction[J].Chin Med J(Engl),2014,127(1):66-71.
[15]YAYLAK B,ALTINTAS B,EDE H,et al.Impact of Coronary Collateral Circulation on In-Hospital Death in Patients with Inferior ST Elevation Myocardial Infarction[J].Cardiol Res Pract,2015:242686.DOI:10.1155/2015/242686.
[16]KIM E K,CHOI J H,SONG Y B,et al.A protective role of early collateral blood flow in patients with ST-segment elevation myocardial infarction[J].Am Heart J,2016,171(1):56-63.DOI:10.1016/j.ahj.2015.10.016.
[17]HARA M,SAKATA Y,NAKATANI D,et al.Impact of coronary collaterals on in-hospital and 5-year mortality after ST-elevation myocardial infarction in the contemporary percutaneous coronary intervention era:a prospective observational study[J].BMJ Open,2016,6(7):e011105.DOI:10.1136/bmjopen-2016-011105.
[18]HERNáNDEZ-PéREZ F J,GOIRIGOLZARRI-ARTAZA J,RESTREPO-CóRDOBA M A,et al.Impact of Coronary Collaterals on Long-term Prognosis in Patients Treated With Primary Angioplasty[J].Rev Esp Cardiol(Engl Ed),2017,70(3):178-185.DOI:10.1016/j.rec.2016.09.023.
[19]SEN?,ALLAHVERDIYEV S,TOPUZ M,et al.Clinical significance and determinants of prompt recruitment collaterals during primary percutaneous coronary intervention[J].Kardiol Pol,2017,75(8):763-769.DOI:10.5603/KP.a2017.0078.
[20]ELIAS J,HOEBERS L P C,VAN DONGEN I M,et al.Impact of Collateral Circulation on Survival in ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention With a Concomitant Chronic Total Occlusion[J].JACC Cardiovasc Interv,2017,10(9):906-914.DOI:10.1016/j.jcin.2017.01.026.
[21]SCHAPER W,ITO W D.Molecular mechanisms of coronary collateral vessel growth[J].Circ Res,1996,79(5):911-919.
[2]FABER J E,CHILIAN W M,DEINDL E,et al.A brief etymology of the collateral circulation[J].Arterioscler Thromb Vasc Biol,2014,34(9):1854-1859.DOI:10.1161/ATVBAHA.114.303929.
[3]PRIES A R,BADIMON L,BUGIARDINI R,et al.Coronary vascular regulation,remodelling,and collateralization:mechanisms and clinical implications on behalf of the working group on coronary pathophysiology and microcirculation[J].Eur Heart J,2015,36(45):3134-3146.DOI:10.1093/eurheartj/ehv100.
[4]MEIER P,HEMINGWAY H,LANSKY A J,et al.The impact of the coronary collateral circulation on mortality:a meta-analysis[J].Eur Heart J,2012,33(5):614-621.DOI:10.1093/eurheartj/ehr308.
[5]STANG A.Critical evaluation of the Newcastle-Ottawa scale for the assessment of thequality of nonrandomized studies in meta-analyses[J].Eur J Epidemiol,2010,25(9):603-605.DOI:10.1007/s10654-010-9491-z.
[6]PéREZ-CASTELLANO N,GARCíA E J,ABEYTUA M,et al.Influence of collateral circulation on in-hospital death from anterior acute myocardial infarction[J].J Am Coll Cardiol,1998,31(3):512-518.
[7]ANTONIUCCI D,VALENTI R,MOSCHI G,et al.Relation between preintervention angiographic evidence of coronary collateral circulation and clinical and angiographic outcomes after primary angioplasty or stenting for acute myocardial infarction[J].Am JCardiol,2002,89(2):121-125.
[8]ELSMAN P,VAN'T HOF A W,DE BOER M J,et al.Role of collateral circulation in the acute phase of ST-segment-elevation myocardial infarction treated with primary coronary intervention[J].Eur Heart J,2004,25(10):854-858.
[9]SORAJJA P,GERSH B J,MEHRAN R,et al.Impact of collateral flow on myocardial reperfusion and infarct size in patients undergoing primary angioplasty for acute myocardial infarction[J].Am Heart J,2007,154(2):379-384.
[10]DESCH S,DE WAHA S,EITEL I,et al.Effect of coronary collaterals on long-term prognosis in patients undergoing primary angioplasty for acute ST-elevation myocardial infarction[J].Am J Cardiol,2010,106(5):605-611.DOI:10.1016/j.amjcard.2010.04.010.
[11]WANG B,HAN Y L,LI Y,et al.Coronary collateral circulation:Effects on outcomes of acute anterior myocardial infarction after primary percutaneous coronary intervention[J].J Geriatr Cardiol,2011,8(2):93-98.DOI:10.3724/SP.J.1263.2011.00093.
[12]赖文文.探讨早期侧枝循环对于急性ST段抬高型前壁心肌梗死直接PCI治疗的患者的影响[D].广东:南方医科大学,2013.
[13]RECHCINSKI T,JASINSKA A,PERUGA J Z,et al.Presence of coronary collaterals in ST-elevation myocardial infarction patients does not affect long-term outcome[J].Pol Arch Med Wewn,2013,123(1/2):29-37.
[14]SHEN Y,WU F,PAN C,et al.Clinical relevance of angiographic coronary collaterals during primary coronary intervention for acute ST-elevation myocardial infarction[J].Chin Med J(Engl),2014,127(1):66-71.
[15]YAYLAK B,ALTINTAS B,EDE H,et al.Impact of Coronary Collateral Circulation on In-Hospital Death in Patients with Inferior ST Elevation Myocardial Infarction[J].Cardiol Res Pract,2015:242686.DOI:10.1155/2015/242686.
[16]KIM E K,CHOI J H,SONG Y B,et al.A protective role of early collateral blood flow in patients with ST-segment elevation myocardial infarction[J].Am Heart J,2016,171(1):56-63.DOI:10.1016/j.ahj.2015.10.016.
[17]HARA M,SAKATA Y,NAKATANI D,et al.Impact of coronary collaterals on in-hospital and 5-year mortality after ST-elevation myocardial infarction in the contemporary percutaneous coronary intervention era:a prospective observational study[J].BMJ Open,2016,6(7):e011105.DOI:10.1136/bmjopen-2016-011105.
[18]HERNáNDEZ-PéREZ F J,GOIRIGOLZARRI-ARTAZA J,RESTREPO-CóRDOBA M A,et al.Impact of Coronary Collaterals on Long-term Prognosis in Patients Treated With Primary Angioplasty[J].Rev Esp Cardiol(Engl Ed),2017,70(3):178-185.DOI:10.1016/j.rec.2016.09.023.
[19]SEN?,ALLAHVERDIYEV S,TOPUZ M,et al.Clinical significance and determinants of prompt recruitment collaterals during primary percutaneous coronary intervention[J].Kardiol Pol,2017,75(8):763-769.DOI:10.5603/KP.a2017.0078.
[20]ELIAS J,HOEBERS L P C,VAN DONGEN I M,et al.Impact of Collateral Circulation on Survival in ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention With a Concomitant Chronic Total Occlusion[J].JACC Cardiovasc Interv,2017,10(9):906-914.DOI:10.1016/j.jcin.2017.01.026.
[21]SCHAPER W,ITO W D.Molecular mechanisms of coronary collateral vessel growth[J].Circ Res,1996,79(5):911-919.