急性非ST抬高型心肌梗死行冠状动脉旁路移植手术时机Meta分析

doi:10.6040/j.issn.1671-7554.0.2024.0961

摘要/Abstract

摘要： 目的探讨急性非ST抬高型心肌梗死(non ST elevated myocardial infarction, NSTEMI)患者行冠状动脉旁路移植术(coronary artery bypass grafting, CABG)的时间间隔对患者临床结局的影响。方法使用计算机搜索引擎在CNKI、Cochrane Library、Web of Science、PubMed、Google Scholar等中英文数据库进行检索,检索时间为建库至2024年7月。Meta分析采用RevMan 5.4软件进行,根据患者确诊NSTEMI至行CABG的时间间隔分别以1 d、3 d、7 d为时间点分为3个亚组,早期组(<1 d、<3 d、<7 d)和延迟组(>1 d、>3 d、>7 d)。首要结局指标为住院期间全因死亡率,次要结局指标为围术期再发心肌梗死和脑卒中发生率。结果共纳入13篇文献,含回顾性研究6个,数据库研究7个,共计657 555例患者。其中10个研究比较了NSTEMI患者1 d内行CABG与1 d后行CABG对患者结局指标的影响,6个研究比较了NSTEMI患者3 d内行CABG与3 d后行CABG对患者结局指标的影响,3个研究比较了NSTEMI患者7 d内行CABG与7 d后行CABG对患者结局指标的影响。Meta分析发现1 d早期组与延迟组相比,全因死亡率较高(OR=1.58, 95%CI:1.09~2.30, P=0.02),差异有统计学意义。围术期再发心梗(OR=0.61, 95%CI:0.28~1.33, P=0.21)和脑卒中(OR=0.95, 95%CI: 0.58~1.55, P=0.82)的风险较低,但差异无统计学意义。3 d早期组与延迟组全因死亡率(OR=1.01,95%CI:0.73~1.41,P=0.95)、围术期再发心梗(OR=0.89,95%CI:0.36~2.18,P=0.79)及脑卒中(OR=1.59,95%CI:0.80~3.17,P=0.19)风险差异无统计学意义。7 d早期组与延迟组全因死亡率差异无统计学意义(OR=1.14, 95%CI:0.63~2.08,P=0.67),未将围术期再发心梗与脑卒中事件列为结局指标。结论急性NSTEMI患者1 d内行CABG手术风险较延迟组高,CABG手术应尽可能推迟到1 d后。

关键词: 急性非ST抬高型心肌梗死, 冠状动脉旁路移植术, 早期手术, 延迟手术, 系统评价, Meta分析

Abstract: Objective To investigate the influence of the time interval of coronary artery bypass grafting(CABG)on the clinical outcomes of patients who suffered from acute non-ST elevated myocardial infarction(NSTEMI). Methods CNKI, PubMed, Web of Science, Cochrane Library and Google Scholar were searched. The search time of the databases was from the establishment of the database to July 2024. Meta-analysis was performed using RevMan 5.4 software and patients were divided into 3 subgroups according to the time interval from diagnosis of NSTEMI to CABG at 1 day, 3 days, and 7 days, respectively, namely the early group(<1 d,<3 d,<7 d)and the delayed group(>1 d,>3 d,>7 d). The primary outcome measure was all-cause mortality during hospitalization, and the secondary outcome measure was the incidence of recurrent myocardial infarction and stroke during perioperative period. Results A total of 13 studies were included, containing 6 retrospective studies and 7 database studies, involving 657 555 patients. Among them, 10 studies compared the impact of CABG within 1 day and after 1 day in NSTEMI patients on patient outcome indicators, 6 studies sorted out the effects of CABG within 3 days and CABG after 3 days in NSTEMI patients on patient outcome indicators, 3 studies examined the effects of CABG within 7 days and CABG after 7 days on outcomes in NSTEMI patients. Meta analysis showed that compared with the delayed group, the all-cause mortality rate was higher in the early 1-day group(OR=1.58, 95%CI:1.09-2.30, P=0.02),and the difference was statistically significant. The risk of perioperative recurrence of myocardial infarction(OR=0.61, 95%CI:0.28-1.33, P=0.21)and stroke(OR=0.95, 95%CI: 0.58-1.55, P=0.82)were lower, but the difference was not statistically significant. There was no statistically significant difference in the all-cause mortality(OR=1.01, 95%CI:0.73-1.41, P=0.95), perioperative recurrence of myocardial infarction(OR=0.89, 95%CI:0.36-2.18, P=0.79)and stroke(OR=1.59, 95%CI:0.80-3.17, P=0.19)risks between the early 3-day group and the delayed group. There was no statistically significant difference in the all-cause mortality rate between the early 7-day group and the delayed group(OR=1.14, 95%CI: 0.63-2.08, P=0.67), and perioperative recurrence of myocardial infarction and stroke were not included as outcome indicators. Conclusion The risk of CABG operation within 1 day in acute NSTEMI patients was higher than that in the delayed group. CABG for NSTEMI patients should be postponed after 1 day if possible.

Key words: Acute non-ST elevation myocardial infarction, Coronary artery bypass grafting, Early surgery, Delayed operation, Systematic review, Meta-analysis

中图分类号:

R654

温学龙,刘安慧,陈经纬,吴梦婷,杨岷. 急性非ST抬高型心肌梗死行冠状动脉旁路移植手术时机Meta分析[J]. 山东大学学报 (医学版), 2025, 63(5): 60-70.

WEN Xuelong, LIU Anhui, CHEN Jingwei, WU Mengting, YANG Min. A Meta-analysis of the timing of coronary artery bypass grafting surgery for acute non-ST myocardial infarction[J]. Journal of Shandong University (Health Sciences), 2025, 63(5): 60-70.

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