Percutaneous Coronary Intervention after Fibrinolysis for ST-Segment Elevation Myocardial Infarction Patients: An Updated Systematic Review and Meta-Analysis

Abstract

BackgroundPercutaneous coronary intervention (PCI), fibrinolysis and the combination of both methods are current therapeutic options for patients with ST-segment elevation myocardial infarction (STEMI).MethodsWe searched PubMed, EMBASE, Google scholar and Cochrane Controlled Trials Register for randomized controlled trials (RCTs) evaluating the efficacy and safety of PCI after fibrinolysis within 24 hours, which was compared with primary PCI alone and ischemia-guided or delayed PCI. Meta-analysis was conducted using Review Manager 5.30 following the methods described by the Cochrane library.ResultsA total of 16 studies including 10,034 patients were enrolled. As compared with primary PCI alone group, the short-term mortality (5.8% vs 4.5%, RR 1.29, 95% confidence interval [CI] 1.00–1.65) and re-infarction rate (4.1% vs 2.7%, RR 1.46, 95%CI 1.05–2.03) were higher in the immediate PCI group (median/mean time ≤ 2 h after fibrinolysis). However, the short-term mortality and re-infarction rate showed no statistically significant differences in the early PCI group (2–24 hours after fibrinolysis). The rate of major bleeding events was higher both in the immediate PCI (6.3% vs 4.4%, RR 1.43, 95%CI 1.11–1.85) and the early PCI group (6.4% vs 4.4%, RR 1.46, 95%CI 1.03–2.06) as compared with primary PCI alone group. As compared with ischemia-guided or delayed PCI, early PCI was associated with significantly reduced re-infarction (2.4% vs 4.0%, RR 0.61, 95%CI 0.41–0.92) and recurrent ischemia (1.5% vs 5.3%, RR 0.29, 95%CI 0.12–0.70) at short-term. And the reduced re-infarction rate was also observed at long-term.ConclusionsEarly PCI after fibrinolysis, with a relatively broader time for PCI preparation, can bring the similar effects with primary PCI alone and is better than ischemia-guided or delayed PCI in STEMI patients with symptom onset < 12 h who cannot receive timely PCI. However, immediate PCI after fibrinolysis is detrimental.

Temporal trends, characteristics and outcomes of fibrinolytic therapy for ST‐elevation myocardial infarction among patients 80 years or older

“…As in our study, lack of extra benefit of FT has been reported in several studies and meta‐analyses . These meta‐analyses also reported higher incidence of major bleeding, without mortality benefit .…”

Primary angioplasty and pharmaco-invasive strategies in the treatment of ST-elevated myocardial infarction

“…Однако различий не было при проведении раннего инвазивного вмешательства в срок от 2 до 24 ч после ТЛТ. Частота больших кровотечений при фармакоинвазивной стратегии была выше и при немедленном -6,3% vs 4,4%, ОР 1,43, 95% ДИ: 1,11-1,85, и при раннем вмешательстве -6,4% vs 4,4%, ОР 1,46, 95% ДИ: 1,03-2,06, по сравнению с первичным ЧКВ [25].…”

Time Course of Endothelial Dysfunction and Atherothrombosis Markers in Patients With Acute Myocardial Infarction With St Segment Elevation and Type 2 Diabetes Mellitus Depending on Reperfusion Therapy Approach

“…According to current data, in addition to these factors, a major role in the development of cardiovascular complications of diabetes belongs to the reduction of fibrinolytic activity [10,11], which is associated with an increase in the concentration and activity of plasminogen activator inhibitor type 1 (IAP-1) [12 ].…”