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首页> 外文期刊>Journal of Clinical Medicine Research >The Effects of Geography on Outcomes of Routine Early Versus Selective Late Revascularization Strategy in the Treatment of Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction: A Meta-Analysis of Transatlantic Randomized Controlled Trials
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The Effects of Geography on Outcomes of Routine Early Versus Selective Late Revascularization Strategy in the Treatment of Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction: A Meta-Analysis of Transatlantic Randomized Controlled Trials

机译：地理因素对不稳定型心绞痛和非ST段抬高型心肌梗死的常规早期和选择性晚期血运重建策略结果的影响：跨大西洋随机对照试验的荟萃分析

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Background: The optimal timing of revascularization in unstable angina (UA) or non-ST-segment elevation myocardial infarction (NSTEMI) remains uncertain. We compared routine early revascularization (REV) versus selective late revascularization (SLR) strategies and divergence in the approach of cardiologists in the United States and Europe. Methods: Seventeen randomized controlled trials (RCTs) (15,812 patients) were extracted from PubMed, Cochrane Library, EMBASE and Web of Science databases. The data were pooled using the Der Simonian and Laird random-effect models and expressed as pooled risk ratios (RR) with 95% confidence intervals (95% CIs). Results: Overall, there was no difference in all-cause mortality (RR: 1.01, 95% CI: 0.95 - 1.08, P = 0.7), myocardial infarction (MI) (RR: 0.98, 95% CI: 0.79 - 1.22, P = 0.85) or coronary artery bypass grafting (CABG) (RR: 1.33, 95% CI: 0.92 - 1.91, P = 0.12) between REV and SLR strategy. There were trends of decreased incidence of MI in REV, 13.3% (1,029/7,704) vs. 15.1% (1,108/7,314) in SLR (P = 0.007), and rate of CABG was higher in REV, 4.9% (140/2,831) vs. 3.7% (105/2,819) in SLR (P = 0.031). There were trends of lower all-cause mortality in the combined US/international trials in both REV 8.4% (390/4,624) vs. 22.8% (908/3,975) (P 0.001) and SLR 8% (359/4,421) vs. 24% (910/3,808) (P 0.001) compared to the European trials. There were also trends of lower rates of MI in the European trials in the REV group 20% (623/3,080) vs. 25% (712/2,893) in SLR (P = 0.001) and higher rates of CABG in REV 8.3% (96/1,144) vs. 5.7% (67/1,165) in SLR (P = 0.02); however, there were no significant effects in the pooled RR ratios even after subgroup analysis between US/international trials and European trials. Conclusions: Despite having contemporary differences in the management approach towards UA/NSTEMI patients, no significant differences in trends were observed with REV strategy in US/international trials vs. European trials.
机译：背景：不稳定型心绞痛（UA）或非ST段抬高型心肌梗死（NSTEMI）的最佳血运重建时机仍不确定。我们比较了常规早期血运重建（REV）与选择性晚期血运重建（SLR）策略以及美国和欧洲心脏病专家的研究方法的分歧。方法：从PubMed，Cochrane图书馆，EMBASE和Web of Science数据库中提取了17项随机对照试验（RCT）（15,812例患者）。使用Der Simonian和Laird随机效应模型对数据进行汇总，并以95％置信区间（95％CI）表示为汇总风险比（RR）。结果：总体而言，全因死亡率（RR：1.01，95％CI：0.95-1.08，P = 0.7），心肌梗塞（MI）（RR：0.98，95％CI：0.79-1.22，P = 0.85）或在REV和SLR策略之间进行冠状动脉搭桥术（CABG）（RR：1.33，95％CI：0.92-1.91，P = 0.12）。 REV的MI发生率呈下降趋势，分别为13.3％（1,029 / 7,704）和SLR的15.1％（1,108 / 7,314）（P = 0.007），而CABG率较高，为4.9％（140 / 2,831） ）对比单反相机中的3.7％（105 / 2,819）（P = 0.031）。在美国/国际联合试验中，全因死亡率有降低的趋势，REV 8.4％（390 / 4,624）vs. 22.8％（908 / 3,975）（P <0.001）和SLR 8％（359 / 4,421）vs与欧洲试验相比为24％（910 / 3,808）（P <0.001）。在REV组中，欧洲试验中的MI发生率也有降低的趋势，SLR的发生率分别为20％（623 / 3,080）和25％（712 / 2,893）（P = 0.001），REV组的CABG发生率较高，为8.3％（P 96/1144）vs.SLR的5.7％（67/1165）（P = 0.02）;但是，即使在美国/国际试验与欧洲试验之间进行了亚组分析之后，合并的RR比率也没有显着影响。结论：尽管在针对UA / NSTEMI患者的治疗方法上存在当代差异，但在美国/国际试验与欧洲试验中，REV策略在趋势上没有观察到显着差异。

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