Routine early coronary angioplasty versus ischaemia-guided angioplasty after thrombolysis in acute ST-elevation myocardial infarction: a meta-analysis

Abstract

Where primary PCI is not feasible, our meta-analysis favours routine early PCI within 24 h of thrombolysis for acute ST-elevation myocardial infarction-a strategy that is safe and a time-target that is easily achievable. Early PCI is associated with reduced recurrence of ischaemia and re-infarction, but at no increased risk of major haemorrhage.

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

“…Both groups achieved adequate results regarding the TIMI flow and MBG with no timing superiority in the first 24 hours. This outcome was consistent with that occurred in the early PCI group in the TRANSFER AMI study which encourage early intervention in first 24 hours [3]. The assessment of LV systolic function showed no difference between both groups.…”

“…The results of our study was supported by a regression analysis of a large meta analysis by D'Souza et al [3] to identify the optimal timing for early PCI after fibrinolysis and the subgroups more likely to benefit. This analysis did not demonstrate a correlation between magnitude of benefit and timing of early PCI.…”

“…All the baseline demographic and clinical data were homogenous between both groups and these results matched with those in the TRANSFER -AMI study where all the Baseline characteristics were well balanced between the two groups except that there was a higher prevalence of previous stroke or transient ischemic attacks in the early-PCI group than in the standard treatment group and a higher prevalence of previous congestive heart failure in the standard-treatment group than in the early-PCI group, and this may be due to higher age group, previous STEMI, previous LV dysfunction and higher Killip class III and IV [5]. The non significant difference between the comparable groups regarding the demographic and clinical data was the same finding in eight randomized controlled trials that were included in a large Meta-analysis done by D'Souza et al [3].…”

“…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.…”

“…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].…”