Key result
Early PCI after successful thrombolysis significantly reduced cardiovascular events compared to standard therapy (OR 0.54) without increasing major bleeding complications.
Why the study?
Does early PCI improve cardiovascular events in patients with STEMI compared to standard therapy?
Meta-Analysis (n=2,535)
Does early PCI improve cardiovascular events in patients with STEMI compared to standard therapy?
Odds Ratio: 0.54 (95% CI 0.47–0.7)
p-value: p=<0.001
Early PCI (pharmaco-invasive strategy) performed 4 to 24 hours after successful thrombolysis significantly reduces cardiovascular events in STEMI patients without increasing bleeding complications.
Supports pharmaco-invasive strategy in STEMI; reinforces meta-analytic evidence for early PCI post-thrombolysis.
OBJECTIVE: Primary Percutaneous Coronary Intervention (PCI) is the treatment of choice for ST-segment Elevation Myocardial Infarction (STEMI) if performed within 90 minutes from first medical contact. However, primary PCI is only available for less than 25% of patients with STEMI. Early PCI or Pharmaco-invasive strategy has evolved from facilitated PCI but with more delayed timing from thrombolysis to PCI. AIM: Assess the safety and effectiveness of Early PCI. PATIENTS AND METHOD: We reviewed the data of the available therapy options for patients with STEMI. Then we performed a meta-analysis for all randomized controlled trials of early PCI versus standard therapy. RESULTS: Five studies fulfilled our inclusion criteria. Our meta-analysis showed improved cardiovascular events with early PCI compared to standard therapy (odd ratio of 0.54; 95% Confidence interval 0.47-0.7, p<0.001). There were no significant bleeding complications when doing early PCI 4 to 24 hours after successful thrombolysis. CONCLUSION: Early PCI should be done to all STEMI patients within 24 hours after successful thrombolysis.
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Shammeri et al. (2013) conducted a meta-analysis in ST-segment Elevation Myocardial Infarction (STEMI) (n=2,535). Early PCI vs. Standard therapy (fibrinolysis alone or ischemia-guided management) was evaluated on Cardiovascular events (OR 0.54, 95% CI 0.47-0.7, p=<0.001). Early PCI after successful thrombolysis significantly reduced cardiovascular events compared to standard therapy (OR 0.54) without increasing major bleeding complications.
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