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摘要
Objective We perform a systematic review to discern if ST resolution achieved via percutaneous coronary intervention (PCI) has a different meaning to that achieved via fibrinolysis.
Background Resolution of ST-segment elevation in acute myocardial infarction has been widely used as a surrogate for treatment success. A recent randomized study suggested that after primary PCI, the prognostic significance of ST resolution may have been overemphasized.
Methods Using the MEDLINE, COCHRANE, EMBASE, and PUBMED databases to search for the relevant papers, we analyze the data with a new ST-resolution score. ST-resolution groups of <30%, 30% to <70%, and >= 70% are given scores of 1, 2, and 3 respectively, whereas ST-resolution groups reported as <50% are scored as 1.5, and >= 50% scored as 2.5.
Results We identify 18 fibrinolysis cohorts (32,341 patients) and 5 PCI cohorts (1,913 patients). The mean ST-resolution score weighted for the number of patients in each cohort is 1.87 +/- 0.15 for PCI and 1.66 +/- 0.20 for fibrinolysis (P<.001). The raw combined 30-day mortality is 4.9% with fibrinolysis and 4.3% with PCI (P=.452 by Poisson regression). There is a linear relationship with lower 30-day mortality associated with higher ST-resolution score. The regression line for the PCI cohorts almost overlaps with that from the fibrinolysis cohorts. On multivariate regression, only ST-resolution score is significant in predicting 30-day mortality. When tested, the interaction term (treatment group x ST resolution score) is never a significant predictor (P>.25 in all models).
Conclusion ST resolution after different reperfusion therapies has similar prognostic meaning. (Am Heart J 2010;160:842-848.e2.)
- 出版日期2010-11
