Efficacy And Safety Of Percutaneous Coronary Intervention In Patients With Acute Myocardial Infarction And Renal Insufficiency:A Meta-Analysis

BackgroundIn recent years,with the improvement of people's living standards,about 17 million people in the world have died of cardiovascular diseases every year,including more than 50% of patients died of acute myocardial infarction(AMI).In the past 10 years,the incidence of acute myocardial infarction in China has been on the rise,and the mortality rate is high.The incidence of the disease has gradually become younger.With the widespread use of percutaneous coronary intervention(PCI)technology,more and more patients with coronary heart disease(CHD)and chronic renal insufficiency(CRF)have been accepted PCI therapy.PurposeThis study aims to further evaluate the efficacy and safety of percutaneous coronary intervention in the treatment of acute myocardial infarction complicated with chronic renal insufficiency by means of meta-analysis.The relevant prognostic indicators include the patient's coronary lesions(count of culprit vessels).Systematic analysis of the incidence of cardiac adverse events and long-term mortality,to provide information and assist interpretation results for PCI patients in the clinical application of PCI in patients with acute myocardial infarction with chronic renal insufficiency in China.Research methodsComputer searches of clinical randomized percutaneous coronary intervention for acute myocardial infarction complicated by chronic renal insufficiency published in PubMed,EMBase,Cochrane Library,CNKI,VIP,Wanfang database,etc.For controlled studies,the search time was from the establishment of the database to December 2017.The two reviewers determined whether the literature was included in the study according to a pre-established standard.The independent assessment of the quality of the included literature and data extraction,using Revman5.1 software for meta-analysis.Through the subgroup analysis of research methods,coronaryvascular lesion counts,and long-term mortality sample size,the source of heterogeneity was explored and the study was more targeted.The funnel plot method was used to analyze the bias.ResultIn this study,a total of 12 trials were included.Of the 331,237 patients with acute myocardial infarction,35,844 had renal insufficiency and 295,393 had normal renal function.Meta-analysis showed that the coronary lesions were evaluated: the coronary lesions in the patients with acute myocardial infarction combined with chronic renal insufficiency and normal renal function(the number of culprit vessels was one)was statistically significant(OR,95%).CI)0.57(0.42,0.76),P <O.O5].The difference in coronary artery lesions(number of culprit vessels ?2)in patients with acute myocardial infarction complicated with chronic renal insufficiency and normal renal function was statistically significant(OR(95%CI)1.50(1.38,1.64),P<O.O5].The assessment of the incidence of major cardiac adverse events:: The difference was statistically significant(OR(95% CI)2.27(1.68,3.07),P < O.O5).Long-term mortality assessment: The difference was statistically significant(OR(95% CI)3.07(2.17,4.33),P < O.O5).In conclusionPercutaneous coronary intervention in the treatment of acute myocardial infarction with chronic renal insufficiency efficacy and safety evaluation,AMI patients with CKD in the coronary artery during coronary intervention include coronary lesions,the incidence of major cardiac adverse events,long-term mortality All have differences,suggesting increased risk of death and hospitalization.