Early routine percutaneous coronary intervention after fibrinolysis vs. standard therapy in ST-segment elevation myocardial infarction: a meta-analysis

Borgia, Francesco; Goodman, Shaun G.; Halvorsen, Sigrun; Cantor, Warren J.; Piscione, Federico; May, Michel R. Le; Fernández‐Avilés, Francisco; Sánchez, Pedro L.; Dimopoulos, Konstantinos; Scheller, Bruno; Armstrong, Paul W.; Mario, Carlo Di

doi:10.1093/eurheartj/ehq204

Cited by 173 publications

(107 citation statements)

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“…Its incidence does not exceed 3.8% in either groups as shown in the two large meta analysis done by Borgia et al [4] and D' Souza et al [3] Most cases of death occurred before day 5 in the early PCI group while in the standard conservative group most cases occur after day 3 as mentioned in the study by Di Mario C et al [6], Cantor WJ et al [5] stated that all cases of mortality occurred in patients presenting in killip class 4.…”

Section: Very Early Versus Early Invasive Strategy After Successful Tmentioning

confidence: 53%

“…In our study we divided the optimum window of routine early intervention post thrombolysis into two groups, a very early group who performed the post thrombolysis intervention [3][4][5][6][7][8][9][10][11][12] hours and an early group who performed the intervention 12-24 hours. Since no other studies were designed to lay bare the assumption that very early revascularization might be superior compared to the early one, within the first 24 hours.…”

Section: Discussionmentioning

confidence: 99%

“…Copyright: ©2016 Abu Arab et al stroke) were assessed at 30 days, whereas only clinical endpoints were assessed at 6-12 months [4]. The trials that addressed the timing issue post thromblysis (The WEST, [20] NORDISTEMI, [7] TRANSFER AMI, [5] CAPITAL AMI, [21] CARESS-IN-AMI [6] and GRACIA1 [18]) showed significant difference between comparable groups regarding the composite end point of death/reinfarction/ recurrent ischemia favoring routine early PCI group over ischemia driven delayed PCI.…”

Section: Very Early Versus Early Invasive Strategy After Successful Tmentioning

confidence: 99%

“…Regarding recurrent ischemia and TVR, Worth mentioning that most of the trials in the stent era that compared routine early invasive strategy with other strategies used bare metal stents [3,4] except only one study the GRACIA 3 used paclitaxel eluting stents [22]. This might raise the suspicion that the results of these studies might have been different if DES were used.…”

Section: Very Early Versus Early Invasive Strategy After Successful Tmentioning

confidence: 99%

“…Early post thrombolysis referral had been discouraged in the past; however multiple studies were performed comparing immediate or early angiography after fibrinolysis versus a more conservative strategy of deferred PCI or ischemia-guided management showed evidence for a reduction in the risk of total mortality in patients undergoing immediate or early PCI with no significant differences in the risk of stroke or major bleeding [3,4].…”

Section: Introductionmentioning

confidence: 99%

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Very Early versus Early Invasive Strategy after Successful Thrombolysis in Patients with ST Segment Elevation Myocardial Infarction

2016

JCCR

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Background: Till this time even with superiority of primary percutaneous coronary intervention (pPCI) in the management of ST segment elevation myocardial infarction (STEMI), most of patients present to hospitals without pPCI facilities receive fibrinolytic therapy. The current recommendations support routine early invasive strategy within 24 hours.Objectives: we aimed at evaluating the best timing of invasive strategy within the first 24 hours. Methods:The study was conducted on 60 STEMI patients who were referred to our center after successful thrombolysis. Patients were randomized into 2 groups: Very early invasive group (n=30): subjected to very early invasive strategy within 3 to 12 hours post thrombolysis. Early invasive group (n=30): subjected to early invasive strategy within 12 to 24 hours. The primary endpoints were the composite endpoints of major adverse cardiac events (MACEs). Secondary endpoints were achievement of TIMI III flow with MBG II or III. Safety endpoints were bleeding complications.Results: Both groups were homogenous regarding the demographic, clinical, and angiographic data before invasive strategy. TIMI III flow and MBG II or III were achieved in 83.3% of patients in the very early invasive group vs. 86.6% in the early group (P = 0.955). There was no difference between both groups regarding the composite endpoints MACEs (P= 0.667) or bleeding complications (P=0.528). Conclusion:The study did not demonstrate a correlation between magnitude of benefit and timing of early PCI post successful thrombolysis in patients with STEMI. Thus, early invasive strategy could be scheduled depending on the logistics of the reference catheterization laboratory within 24 hours post thrombolysis.

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Section: Very Early Versus Early Invasive Strategy After Successful Tmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Very Early Versus Early Invasive Strategy After Successful Tmentioning

confidence: 99%

Section: Very Early Versus Early Invasive Strategy After Successful Tmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Very Early versus Early Invasive Strategy after Successful Thrombolysis in Patients with ST Segment Elevation Myocardial Infarction

2016

JCCR

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Fibrinolysis Use Among Patients Requiring Interhospital Transfer for ST-Segment Elevation Myocardial Infarction Care

et al. 2015

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IMPORTANCE Guidelines for patients with ST-segment elevation myocardial infarction (STEMI) recommend timely reperfusion with primary percutaneous coronary intervention (pPCI) or fibrinolysis. Among patients with STEMI who require interhospital transfer, it is unclear how reperfusion strategy selection and outcomes vary with interhospital drive times. OBJECTIVE To assess the association of estimated interhospital drive times with reperfusion strategy selection among transferred patients with STEMI in the United States. DESIGN, SETTING, AND PARTICIPANTS We identified 22 481 patients eligible for pPCI or fibrinolysis who were transferred from 1771 STEMI referring centers to 366 STEMI receiving centers in the Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines database between July 1, 2008, and March 31, 2012. MAIN OUTCOMES AND MEASURESIn-hospital mortality and major bleeding. RESULTSThe median estimated interhospital drive time was 57 minutes (interquartile range [IQR], 36-88 minutes). When the estimated drive time exceeded 30 minutes, only 42.6% of transfer patients treated with pPCI achieved the first door-to-balloon time within 120 minutes. Only 52.7% of eligible patients with a drive time exceeding 60 minutes received fibrinolysis. Among 15 437 patients with estimated drive times of 30 to 120 minutes who were eligible for fibrinolysis or pPCI, 5296 (34.3%) received pretransfer fibrinolysis, with a median door-to-needle time of 34 minutes (IQR, 23-53 minutes). After fibrinolysis, the median time to transfer to the STEMI receiving center was 49 minutes (IQR, 34-69 minutes), and 97.1% underwent follow-up angiography. Patients treated with fibrinolysis vs pPCI had no significant mortality difference (3.7% vs 3.9%; adjusted odds ratio, 1.13; 95% CI, 0.94-1.36) but had higher bleeding risk (10.7% vs 9.5%; adjusted odds ratio, 1.17; 95% CI, 1.02-1.33). CONCLUSIONS AND RELEVANCEIn the United States, neither fibrinolysis nor pPCI is being optimally used to achieve guideline-recommended reperfusion targets. For patients who are unlikely to receive timely pPCI, pretransfer fibrinolysis, followed by early transfer for angiography, may be a reperfusion option when potential benefits of timely reperfusion outweigh bleeding risk.

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The Role of Thrombolytic Therapy in the Era of STEMI Interventions

Mercado¹,

Schreiber²,

Grines³

2017

Manual of STEMI Interventions

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Early routine percutaneous coronary intervention after fibrinolysis vs. standard therapy in ST-segment elevation myocardial infarction: a meta-analysis

Abstract: Early routine PCI after fibrinolysis in STEMI patients significantly reduced reinfarction and recurrent ischaemia at 1 month, with no significant increase in adverse bleeding events compared to standard therapy. Benefits of early PCI persist at 6-12 month follow-up.

Cited by 173 publications

References 36 publications

Very Early versus Early Invasive Strategy after Successful Thrombolysis in Patients with ST Segment Elevation Myocardial Infarction

Very Early versus Early Invasive Strategy after Successful Thrombolysis in Patients with ST Segment Elevation Myocardial Infarction

Fibrinolysis Use Among Patients Requiring Interhospital Transfer for ST-Segment Elevation Myocardial Infarction Care

The Role of Thrombolytic Therapy in the Era of STEMI Interventions

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