Why the study?
Does the combination of thrombolytics, anticoagulants, antiplatelets, and primary angioplasty improve mortality and reinfarction rates compared to less complex regimens in patients with STEMI?
Systematic Review (n=404,556)
Does the combination of thrombolytics, anticoagulants, antiplatelets, and primary angioplasty improve mortality and reinfarction rates compared to less complex regimens in patients with STEMI?
Increasing the complexity of STEMI treatment with multiple antithrombotic agents and primary angioplasty significantly reduces mortality while increasing major bleeding, with overall benefits outweighing risks.
Supports intensified antithrombotic regimens in STEMI for mortality benefit; extends meta-analytic evidence on bleeding trade-offs.
Objectives. Assess the impact of associating thrombolytics, anticoagulants, antiplatelets, and primary angioplasty (PA) on death, reinfarction (AMI), and major bleeding (MB) in STEMI therapy. Methods. Medline search was performed to identify randomized trials comparing these classes in STEMI treatment, at least 500 patients, providing death, AMI, and MB rates. Similar arms were grouped. Correlation between number of drugs and PA and the outcomes was evaluated, as well as correlation between the year of the study and the outcomes. Results. Fifty-nine papers remained after exclusions. 404.556 patients were divided into 35 groups of arms. There was correlation between the number of drugs and rates of death (r = -0.466, P = 0.005) and MB (r = 0.403, P = 0.016), confirmed by multivariate regression. This model also showed that PA is associated with lower mortality and increased MB. Year and period of publication correlated with the outcomes: death (r = -0.380, P < 0.001), MB (r = 0.212, P = 0.014), and AMI (r = -0.231, P = 0.009). Conclusion. The increasing complexity of STEMI treatment has resulted in significant reduction in mortality along with increased rates of MB. Overall, however, the benefits of treatment outweigh the associated risks of MB.
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Nascimento et al. (2014) conducted a systematic review in ST Segment Elevation Myocardial Infarction (STEMI) (n=404,556). Thrombolytics, anticoagulants, antiplatelets, and primary angioplasty was evaluated on Rates of death, reinfarction (AMI), and major bleeding (MB) (r = -0.466 for death; r = 0.403 for MB, p=P = 0.005 for death; P = 0.016 for MB).
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