經皮冠狀動脈介入術前他汀治療預防圍手術期患者心肌梗死效果的Meta分析_《中國循證醫學雜志》

作者：

 馬寶新 ¹ , 李花 ¹ , 劉現亮 ¹ , 吳綏生 ²

1. 濱州醫學院附屬醫院（濱州 256603）；2. 吉林大學第一醫院（長春 130021）;

關鍵詞：

冠狀動脈粥樣硬化經皮冠狀動脈介入術他汀類藥物 Meta分析系統評價隨機對照試驗

DOI：

10.7507/1672-2531.20120173

視頻：

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目的　系統評價經皮冠狀動脈介入術（PCI）術前使用他汀治療預防圍手術期冠心病患者心肌梗死的有效性。
方法　計算機檢索CNKI、CBM、MEDLINE和The Cochrane Library，收集PCI術前他汀治療對心血管事件影響的隨機對照試驗，檢索時限均從1990年1月至2011年5月。由2位評價者按照納入和排除標準篩選文獻、提取資料并進行方法學質量評價，然后采用RevMan 5.0軟件進行Meta分析。
結果　最終納入10個隨機對照試驗，共3 012例冠心病患者。Meta分析結果顯示：在圍手術期，對照組1 498例中有207例發生心肌梗死，他汀治療組1 514例中有98例發生心肌梗死，兩組差異有統計學意義［OR=0.43，95% CI（0.34，0.56），P lt;0.000 01］；對照組有226例發生主要心臟不良事件，他汀治療組103例發生主要心臟不良事件，兩組差異有統計學意義［OR=0.41，95% CI（0.32，0.53），P lt; 0.000 01］。
結論　與安慰劑治療相比，PCI術前應用他汀類藥物可明顯降低圍手術期冠心病患者心肌梗死發生率和主要心臟不良事件。受納入研究數量和質量所限，上述結論尚需開展更多高質量大樣本研究驗證。

引用本文： 馬寶新,李花,劉現亮,吳綏生. 經皮冠狀動脈介入術前他汀治療預防圍手術期患者心肌梗死效果的Meta分析. 中國循證醫學雜志, 2012, 12(9): 1110-1115. doi: 10.7507/1672-2531.20120173 復制

1.	Veselka J, Prochazkova S, Duchonova R, et al. Preprocedural statin therapy reduces the risk and extent of cardiac biomarker release following percutaneous coronary intervention. Heart Vessels, 2006, 21(3): 146-151.
2.	Lev EI, Kornowski R, Vaknin-Assa H, et al. Effect of previous treatment with statins on outcome of patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. Am J Cardiol, 2009, 103(2): 165-169.
3.	Zhang M, Que B, Nie SP, et al. The effect of pre-hospital statins therapy on incidence of in-hospital death and total MACCE in patients with PCI. J Clin Pharm Ther, 2008, 33(6): 613-617.
4.	Pasceri V, Patti G, Nusca A, et al. Randomized trial of atorvastatin for reduction of myocardial damage during coronary intervention: results from the ARMYDA (Atorvastatin for Reduction of MYocardial Damage during Angioplasty) study. Circulation, 2004, 110(6): 674-678.
5.	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 Am Coll Cardiol, 2007, 49(12): 1272-1278.
6.	Briguori C, Visconti G, Focaccio A, et al. Novel approaches for preventing or limiting events (Naples) II trial: impact of a single high loading dose of atorvastatin on periprocedural myocardial infarction. J Am Coll Cardiol, 2009, 54(23): 2157-2163.
7.	Veselka J, Zemanek D, Hajek P, et al. Effect of two-day atorvastatin pretreatment on the incidence of periprocedural myocardial infarction following elective percutaneous coronary intervention: a single-center, prospective, and randomized study. Am J Cardiol, 2009, 104(5): 630-633.
8.	Yun KH, Jeong MH, Oh SK, et al. The beneficial effect of high loading dose of rosuvastatin before percutaneous coronary intervention in patients with acute coronary syndrome. Int J Cardiol, 2009, 137(3): 246-251.
9.	Briguori C, Colombo A, Airoldi F, et al. Statin administration before percutaneous coronary intervention: impact on periprocedural myocardial infarction. Eur Heart J, 2004, 25(20): 1822-1828.
10.	Cay S, Cagirci G, Sen N, et al. Prevention of peri-procedural myocardial injury using a single high loading dose of rosuvastatin. Cardiovasc Drugs Ther, 2010, 24(1): 41-47.
11.	Di Sciascio 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 Am Coll Cardiol, 2009, 54(6): 558-565.
12.	Toso A, Leoncini M, Maioli M, et al. Short-term high-dose atorvastatin for periprocedural myocardial infarction prevention in patients with renal dysfunction. J Cardiovasc Med (Hagerstown), 2011, 12(5): 318-321.
13.	Yu XL, Zhang HJ, Ren SD, et al. Effects of loading dose of atorvastatin before percutaneous coronary intervention on periprocedural myocardial injury. Coron Artery Dis, 2011, 22(1): 87-91.
14.	Ray KK, Cannon CP, McCabe CH, et al. Early and late benefits of high-dose atorvastatin in patients with acute coronary syndromes: results from the PROVE IT-TIMI 22 trial. J Am Coll Cardiol, 2005, 46(8): 1405-1410.
15.	Schwartz GG, Olsson AG, Ezekowitz MD, et al. Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: the MIRACL study: a randomized controlled trial. JAMA, 2001, 285(13): 1711-1718.
16.	Ebrahimi R, Saleh J, Toggart E, et al. Effect of preprocedural statin use on procedural myocardial infarction and major cardiac adverse events in percutaneous coronary intervention: a meta-analysis. J Invasive Cardiol, 2008, 20(6): 292-295.
17.	Takemoto M, Liao JK. Pleiotropic effects of 3-hydroxy-3-methylglutaryl coenzyme a reductase inhibitors. Arterioscler Thromb Vasc Biol, 2001, 21(11): 1712-1719.
18.	Sposito AC, Chapman MJ. Statin therapy in acute coronary syndromes: mechanistic insight into clinical benefit. Arterioscler Thromb Vasc Biol, 2002, 22(10): 1524-1534.
19.	Nishino M, Hoshida S, Kato H, et al. Preprocedural statin administration can reduce thrombotic reaction after stent implantation. Circ J, 2008, 72(2): 232-237.

1. Veselka J, Prochazkova S, Duchonova R, et al. Preprocedural statin therapy reduces the risk and extent of cardiac biomarker release following percutaneous coronary intervention. Heart Vessels, 2006, 21(3): 146-151.
2. Lev EI, Kornowski R, Vaknin-Assa H, et al. Effect of previous treatment with statins on outcome of patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. Am J Cardiol, 2009, 103(2): 165-169.
3. Zhang M, Que B, Nie SP, et al. The effect of pre-hospital statins therapy on incidence of in-hospital death and total MACCE in patients with PCI. J Clin Pharm Ther, 2008, 33(6): 613-617.
4. Pasceri V, Patti G, Nusca A, et al. Randomized trial of atorvastatin for reduction of myocardial damage during coronary intervention: results from the ARMYDA (Atorvastatin for Reduction of MYocardial Damage during Angioplasty) study. Circulation, 2004, 110(6): 674-678.
5. 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 Am Coll Cardiol, 2007, 49(12): 1272-1278.
6. Briguori C, Visconti G, Focaccio A, et al. Novel approaches for preventing or limiting events (Naples) II trial: impact of a single high loading dose of atorvastatin on periprocedural myocardial infarction. J Am Coll Cardiol, 2009, 54(23): 2157-2163.
7. Veselka J, Zemanek D, Hajek P, et al. Effect of two-day atorvastatin pretreatment on the incidence of periprocedural myocardial infarction following elective percutaneous coronary intervention: a single-center, prospective, and randomized study. Am J Cardiol, 2009, 104(5): 630-633.
8. Yun KH, Jeong MH, Oh SK, et al. The beneficial effect of high loading dose of rosuvastatin before percutaneous coronary intervention in patients with acute coronary syndrome. Int J Cardiol, 2009, 137(3): 246-251.
9. Briguori C, Colombo A, Airoldi F, et al. Statin administration before percutaneous coronary intervention: impact on periprocedural myocardial infarction. Eur Heart J, 2004, 25(20): 1822-1828.
10. Cay S, Cagirci G, Sen N, et al. Prevention of peri-procedural myocardial injury using a single high loading dose of rosuvastatin. Cardiovasc Drugs Ther, 2010, 24(1): 41-47.
11. Di Sciascio 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 Am Coll Cardiol, 2009, 54(6): 558-565.
12. Toso A, Leoncini M, Maioli M, et al. Short-term high-dose atorvastatin for periprocedural myocardial infarction prevention in patients with renal dysfunction. J Cardiovasc Med (Hagerstown), 2011, 12(5): 318-321.
13. Yu XL, Zhang HJ, Ren SD, et al. Effects of loading dose of atorvastatin before percutaneous coronary intervention on periprocedural myocardial injury. Coron Artery Dis, 2011, 22(1): 87-91.
14. Ray KK, Cannon CP, McCabe CH, et al. Early and late benefits of high-dose atorvastatin in patients with acute coronary syndromes: results from the PROVE IT-TIMI 22 trial. J Am Coll Cardiol, 2005, 46(8): 1405-1410.
15. Schwartz GG, Olsson AG, Ezekowitz MD, et al. Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: the MIRACL study: a randomized controlled trial. JAMA, 2001, 285(13): 1711-1718.
16. Ebrahimi R, Saleh J, Toggart E, et al. Effect of preprocedural statin use on procedural myocardial infarction and major cardiac adverse events in percutaneous coronary intervention: a meta-analysis. J Invasive Cardiol, 2008, 20(6): 292-295.
17. Takemoto M, Liao JK. Pleiotropic effects of 3-hydroxy-3-methylglutaryl coenzyme a reductase inhibitors. Arterioscler Thromb Vasc Biol, 2001, 21(11): 1712-1719.
18. Sposito AC, Chapman MJ. Statin therapy in acute coronary syndromes: mechanistic insight into clinical benefit. Arterioscler Thromb Vasc Biol, 2002, 22(10): 1524-1534.
19. Nishino M, Hoshida S, Kato H, et al. Preprocedural statin administration can reduce thrombotic reaction after stent implantation. Circ J, 2008, 72(2): 232-237.

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《中國循證醫學雜志》

經皮冠狀動脈介入術前他汀治療預防圍手術期患者心肌梗死效果的Meta分析

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