A-66 | Thrombolytics Assisted Invasive Approach versus Primary Percutaneous Coronary Intervention in Patients with ST-Elevation Myocardial Infarction: An Updated Meta-Analysis of Randomized Controlled Trials

Primary Percutaneous Intervention (PPCI) is preferred strategy for reperfusion in STEMI management. Logistical barriers limit the availability and optimal timing of PPCI. Alternative approach includes use of thrombolytics assisted invasive (TAI) reperfusion. We searched databases for RCTs between 2000-2023, comparing TAI approach versus PPCI in STEMI. Random effects meta-analysis was performed to estimate risk ratio (RR) with 95% confidence interval (CI). TAI approach was divided into facilitated PCI (invasive in <2 hours) or pharmaco-invasive (2-24 hours). 13 RCTs with 7,700 patients (TAI: 3,935, PPCI: 3,765, mean follow up 3.8 months) were included. Compared to PPCI, TAI was associated with increased risk of reinfarction (RR 1.34, 1.03-1.76; p=0.03), major bleeding (1.33, 1.04-1.69; p=0.02), intracranial bleeding (4.46, 1.79-11.3; p=0.001) and stroke (2.51, 1.29-4.87; p=0.007). Risk of death, heart failure and cardiogenic shock were similar. Subgroup analysis: risk of reinfarction (p=0.03) and heart failure (p=0.03) was increased in facilitated PCI. Risk of major bleeding numerically increased in both subgroups, but not statistically significant. Intracranial bleeding was increased in both facilitated PCI (p=0.05) and pharmaco-invasive (p=0.02), while stroke was only increased in pharmaco-invasive approach (p=0.01). Risk of death and cardiogenic shock was similar in both the subgroups compared to PPCI. In patients with STEMI, TAI approach was associated with increased risk of reinfarction, major bleeding, intracranial bleeding and stroke when compared to PPCI.