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AHJ：主动脉内球囊反搏增加PCI患者住院死亡率

2013-04-03 欧柏青 译 医学论坛网

主动脉内球囊反搏PCI住院死亡率
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　　虽然目前指南推荐对急性心肌梗死（AMI）合并心源性休克患者使用主动脉内球囊反搏术(IABP)，但现有证据尚不充分，而且最近的两个荟萃分析还得出了不利的结果。 　　意大利学者的一项研究表明，IABP支持可显著改善溶栓治疗再灌注的疗效，但可显著增加直接PCI患者住院死亡率。相关论文2013年3月27日在线发表于《美国心脏杂志》（Am  Heart J）上。 　　研

　　虽然目前指南推荐对急性心肌梗死（AMI）合并心源性休克患者使用主动脉内球囊反搏术(IABP)，但现有证据尚不充分，而且最近的两个荟萃分析还得出了不利的结果。

　　意大利学者的一项研究表明，IABP支持可显著改善溶栓治疗再灌注的疗效，但可显著增加直接PCI患者住院死亡率。相关论文2013年3月27日在线发表于《美国心脏杂志》（Am  Heart J）上。

　　研究者收集了1986年1月1日-2012年12月31日发表的文章进行荟萃分析，用危险比（RR）和风险差（RD）评估IABP对使用不同治疗方法【包括经皮冠状动脉介入治疗（PCI）、溶栓或不进行再灌注的药物治疗】的AMI合并心源性休克患者的住院死亡率、安全终点（卒中和严重出血）和长期生存的影响。

　　结果显示，（1）IABP组与对照组相比死亡风险无明显差异（RR 0.95, P = 0.52; RD −0.04, P = 0.28）；（2）溶栓亚组死亡风险显著降低(RR 0.77, P < 0.0001; RD −0.16, P < 0.0001)；(3) PCI亚组死亡风险显著增加(RR 1.18, P = 0.01; RD 0.07, P =0 .01)。次要终点各组无显著差异。

与PCI相关的拓展阅读：


The outcome of intra-aortic balloon pump support in acute myocardial infarction complicated by cardiogenic shock according to the type of revascularization: A comprehensive meta-analysis

Aims
Despite the recommendations of the current guidelines, scientific evidence continue to challenge the effectiveness of intra-aortic balloon pump (IABP) in acute myocardial infarction (AMI) complicated by cardiogenic shock. Moreover, 2 recent meta-analyses showed contrasting results. The aim of this study is to test the effect of IABP according to the type of therapeutic treatment of AMI: percutaneous coronary intervention (PCI), thrombolytic therapy (TT), or medical therapy without reperfusion. Articles published from January 1, 1986, to December 31, 2012, were collected and analyzed by meta-analysis.
Methods and results
We evaluated the IABP impact on inhospital mortality, on safety end points (stroke, severe bleeding) and long-term survival, using risk ratio (RR) and risk difference (RD) estimates. We found that the risk of death was (i) not significantly different between the IABP and control groups (RR 0.95, P = .52; RD −0.04, P = .28), (ii) significantly reduced in the TT subgroup (RR 0.77, P < .0001; RD −0.16, P < .0001), and (iii) significantly increased in the PCI subgroup (RR 1.18, P = .01; RD 0.07, P = .01). There were no significant differences in secondary end points (P, not significant). In addition, we compared the meta-analyses collected over the same search period.
Conclusion
The results show that IABP support is significantly effective in TT reperfusion but is associated with a significant increase of the inhospital mortality with primary PCI. The comparison of the meta-analyses demonstrates the key role of analysing primary clinical treatments to avoid systematic errors.

    

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    2013-07-08 zhmscau

    #PCI患者#

    0

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    2013-04-05 changjitao2009

    #住院死亡率#

    0

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    2013-04-05 花花1366

    #球囊#

    0

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    2013-04-05 circumcision

    #主动脉#

    0

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Circulation:IABP，为高危PCI护航

　　英国BCIS-1（球囊泵辅助冠状动脉干预研究-1）最新分析结果提示，对于严重缺血性心脏病接受经皮冠脉介入治疗（PCI）的患者，使用主动脉内球囊反搏（IABP）可显著降低患者的全因死亡率。文献于12月6日在线发表于《循环》（Circulation）杂志。 　　研究简介 　　BCIS-1研究是一项前瞻性、随机对照研究，共纳入301例左心功能障碍（左室射血分数<30%）和严重冠脉疾病的患者