经皮冠状动脉介入术前他汀治疗预防围手术期患者心肌梗死效果的Meta分析_《中国循证医学杂志》

作者：

 马宝新 ¹ , 李花 ¹ , 刘现亮 ¹ , 吴绥生 ²

1. 滨州医学院附属医院（滨州 256603）；2. 吉林大学第一医院（长春 130021）;

关键词：

冠状动脉粥样硬化经皮冠状动脉介入术他汀类药物 Meta分析系统评价随机对照试验

DOI：

10.7507/1672-2531.20120173

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　系统评价经皮冠状动脉介入术（PCI）术前使用他汀治疗预防围手术期冠心病患者心肌梗死的有效性。
方法　计算机检索CNKI、CBM、MEDLINE和The Cochrane Library，收集PCI术前他汀治疗对心血管事件影响的随机对照试验，检索时限均从1990年1月至2011年5月。由2位评价者按照纳入和排除标准筛选文献、提取资料并进行方法学质量评价，然后采用RevMan 5.0软件进行Meta分析。
结果　最终纳入10个随机对照试验，共3 012例冠心病患者。Meta分析结果显示：在围手术期，对照组1 498例中有207例发生心肌梗死，他汀治疗组1 514例中有98例发生心肌梗死，两组差异有统计学意义［OR=0.43，95% CI（0.34，0.56），P lt;0.000 01］；对照组有226例发生主要心脏不良事件，他汀治疗组103例发生主要心脏不良事件，两组差异有统计学意义［OR=0.41，95% CI（0.32，0.53），P lt; 0.000 01］。
结论　与安慰剂治疗相比，PCI术前应用他汀类药物可明显降低围手术期冠心病患者心肌梗死发生率和主要心脏不良事件。受纳入研究数量和质量所限，上述结论尚需开展更多高质量大样本研究验证。

引用本文： 马宝新,李花,刘现亮,吴绥生. 经皮冠状动脉介入术前他汀治疗预防围手术期患者心肌梗死效果的Meta分析. 中国循证医学杂志, 2012, 12(9): 1110-1115. doi: 10.7507/1672-2531.20120173 复制

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.

《中国循证医学杂志》

经皮冠状动脉介入术前他汀治疗预防围手术期患者心肌梗死效果的Meta分析

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《中国循证医学杂志》

经皮冠状动脉介入术前他汀治疗预防围手术期患者心肌梗死效果的Meta分析

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