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

Liu F, Guo Q, Xie G, Zhang H, Wu Y, Yang L - PLoS ONE (2015)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Postgraduate, Third Military Medical University, Chongqing, China; Department of Postgraduate, Second Military Medical University, Shanghai, China.

ABSTRACT

Background: Percutaneous coronary intervention (PCI), fibrinolysis and the combination of both methods are current therapeutic options for patients with ST-segment elevation myocardial infarction (STEMI).

Methods: We 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.

Results: A 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.

Conclusions: Early 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.

No MeSH data available.


Related in: MedlinePlus

Long-term re-infarction for immediate or early percutaneous coronary intervention (PCI) after fibrinolysis versus ischemia-guided or delayed PCI.
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pone.0141855.g007: Long-term re-infarction for immediate or early percutaneous coronary intervention (PCI) after fibrinolysis versus ischemia-guided or delayed PCI.

Mentions: The re-infarction rate was lower in the immediate or early PCI group than that in ischemia-guided or delayed PCI group at short-term (47/1697 vs 77/1679, RR 0.61, 95%CI 0.42–0.87) and long-term (54/1213 vs 84/1198, RR 0.64, 95%CI 0.46–0.90, Fig 7). Subgroup analysis showed that compared with ischemia-guided or delayed PCI at short-term, the re-infarction rate was similar in the immediate PCI group (10/182 vs 17/181, RR 0.59, 95%CI 0.28–1.26) but lower in the early PCI group(37/1515 vs 60/1498, RR 0.61, 95%CI 0.41–0.92). Similar effects were observed at long-term (Fig 7A and Fig 7B).


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

Liu F, Guo Q, Xie G, Zhang H, Wu Y, Yang L - PLoS ONE (2015)

Long-term re-infarction for immediate or early percutaneous coronary intervention (PCI) after fibrinolysis versus ischemia-guided or delayed PCI.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4629904&req=5

pone.0141855.g007: Long-term re-infarction for immediate or early percutaneous coronary intervention (PCI) after fibrinolysis versus ischemia-guided or delayed PCI.
Mentions: The re-infarction rate was lower in the immediate or early PCI group than that in ischemia-guided or delayed PCI group at short-term (47/1697 vs 77/1679, RR 0.61, 95%CI 0.42–0.87) and long-term (54/1213 vs 84/1198, RR 0.64, 95%CI 0.46–0.90, Fig 7). Subgroup analysis showed that compared with ischemia-guided or delayed PCI at short-term, the re-infarction rate was similar in the immediate PCI group (10/182 vs 17/181, RR 0.59, 95%CI 0.28–1.26) but lower in the early PCI group(37/1515 vs 60/1498, RR 0.61, 95%CI 0.41–0.92). Similar effects were observed at long-term (Fig 7A and Fig 7B).

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Postgraduate, Third Military Medical University, Chongqing, China; Department of Postgraduate, Second Military Medical University, Shanghai, China.

ABSTRACT

Background: Percutaneous coronary intervention (PCI), fibrinolysis and the combination of both methods are current therapeutic options for patients with ST-segment elevation myocardial infarction (STEMI).

Methods: We 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.

Results: A 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.

Conclusions: Early 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.

No MeSH data available.


Related in: MedlinePlus