Key Points
- To determine whether thrombolysis followed by immediate or early percutaneous coronary intervention (PCI) is safe, feasible, and superior to conservative management in ST-segment elevation myocardial infarction.
- Systematic search of MEDLINE, EMBASE, Cochrane databases, and AHA Master Library up to 2004 with study quality independently evaluated by two reviewers.
- Quantitative meta-analysis evaluating the effect of immediate or early post-thrombolysis PCI versus conservative care on all-cause mortality at 6 to 12 months.
- Across all identified studies (13 supportive, 16 neutral or opposing), the overall difference in mortality between the invasive strategy and conservative care was nonsignificant.
- In 3 stent-era trials, the invasive strategy significantly reduced mortality compared to conservative care (5.8% vs. 10.0%, OR 0.55, 95% CI 0.32-0.92), demonstrating a significant difference in treatment effect compared to pre-stent-era trials.
- Early PCI demonstrated clear clinical benefit specifically in patients with myocardial infarction complicated by cardiogenic shock, hemodynamic instability, or persistent ischemic symptoms.
Structured PICO
Does immediate or early PCI after thrombolysis reduce mortality in patients with ST-segment elevation myocardial infarction?
PPopulationPatients with ST-segment elevation myocardial infarction treated with thrombolysis
IInterventionImmediate or early percutaneous coronary intervention (PCI) after thrombolysis
CComparatorConservative management
OOutcomeMortality at 6-12 monthshard clinical
Routine immediate PCI after thrombolysis is not supported by overall evidence, though contemporary stent-era trials suggest a potential mortality benefit that requires confirmation.