血管紧张素转换酶抑制剂对左心室功能不全得的冠心病患者预后的影响

摘要

目的 采用meta分析评价长期应用血管紧张素转换酶抑制剂(ACEI)是否减少无左心室功能不全的冠心病患者主要心血管事件的发生风险.方法 检索MEDLINE、EMBASE数据库、IPA数据库、Cochrane图书馆.检索词:angiotensin-converting enzyme inhibitors,coronary artery disease,coronary heart disease randomi(s)zed controlled trials,clinical trials,myocardial infarction.入选试验满足条件:试验为随机对照试验,研究对象为无左心室功能不全的冠心病患者,随访时间不少于2年.在检索到的文章中共有7个试验(HOPE、PART-2、QUIET、EOROPA、PEACE、CAMELOT、IMAGINE)满足条件,总计36053例患者.采用比值比OR和95%置信区间(CI)作为评价ACEI和安慰剂治疗差异有无统计学意义的指标.应用RevMan5.0软件行统计学分析.结果 采用ACEI治疗可明显减少总病死率(OR=0.86,95%CI为0.80～0.94)、心血管病死率(OR=0.82,95%CI为0.74～0.91)、非致死性心肌梗死的发生率(OR=0.85,95%CI为0.76～0.95)及脑卒中或短暂性脑缺血发作的发生率(OR=0.78,95%CI为0.67～0.91),其他事件如心脏停搏后复苏、血管成形术、心力衰竭入院等发生率也减少.结论 ACEI可明显降低无左心室功能不全的冠心病患者的总病死率和心血管事件发生率.%Objective To determine whether long-term use of angiotensin-converting enzyme inhibitors ( ACEIs ) could reduce major cardiovascular events and mortality in patients with coronary artery disease ( CAD ) and without left ventricular systolic dysfunction. Methods We searched MEDLINE, EMBASE, and IPA databases. Search terms included angiotensin-converting enzyme inhibitors, coronary artery disease, coronary heart disease randomi ( s ) zed controlled trials, clinical trials, and myocardial infarction. Eligible studies included randomized controlled trials in patients with CAD and without heart failure or left ventricular dysfunction, with follow-up of 2 years or longer. Of 1153 publications screened, 7 met inclusion criteria including HOPE, PART-2, EUROPA, QUIET, PEACE, CAMELOT and IMAGINE, with a total of 36053 patients. Results Treatment with ACEIs reduced overall mortality ( OR =0. 86; 95% CI: 0. 80-0. 94 ), cardiovascular mortality ( OR = 0. 82; 95% CI: 0. 74-0. 91 ), myocardial infarction ( OR = 0. 85 ; 95% CI: 0. 76-0. 95 ), and stroke or transient ischemia attack ( TIA ) ( OR = 0. 78; 95% CI: 0. 66-0. 91 ) compared with those without ACEIs. Other end points events, including resuscitation after cardiac arrest, myocardial revascularization and hospitalization due to heart failure, were also reduced. Conclusions ACEIs reduce total mortality and major cardiovascular end points in patients with CAD and without left ventricular dysfunction.