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BMC Cardiovascular Disorders Feb 2018Xanthine oxidase inhibitors (XOI), classified as purine-like (allopurinol and oxypurinol) and non-purine (febuxostat and topiroxostat) XOI, present antioxidant... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Xanthine oxidase inhibitors (XOI), classified as purine-like (allopurinol and oxypurinol) and non-purine (febuxostat and topiroxostat) XOI, present antioxidant properties by reducing the production of reactive oxygen species derived from purine metabolism. Oxidative stress is an important factor related to endothelial dysfunction and ischemia-reperfusion injury, and may be implicated in the pathogenesis of heart failure, hypertension, and ischemic heart disease. However, there is contradictory evidence regarding the possible cardiovascular (CV) protective effect exerted by XOI. Our objective is to compare the incidence of major adverse cardiovascular events (MACE), mortality, total (TCE) and specific CV events in randomized controlled trials (RCTs) testing XOI against placebo or no treatment.
METHODS
PubMed, EMBASE, Web of Science, Cochrane Central, Lilacs databases were searched from inception to Dec 30 2016, along with hand searching. RCTs including exclusively adult individuals, lasting ≥ 4 weeks, with no language restriction, were eligible. Independent paired researchers selected studies and extracted data. Considering the expected rarity of events, Peto and DerSimonian/Laird odds ratios (OR), the latter in case of heterogeneity, were used for analysis. Random-effects meta-regression was used to explore heterogeneity.
RESULTS
The analysis of MACE included 81 articles (10,684 patients, 6434 patient-years). XOI did not significantly reduce risk of MACE (OR = 0.71, 95% CI 0.46-1.09) and death (0.89, 0.59-1.33), but reduced risk of TCE (0.60, 0.44-0.82; serious TCE: 0.64, 0.46 to 0.89), and hypertension (0.54, 0.37 to 0.80). There was protection for MACE in patients with previous ischemic events (0.42, 0.23-0.76). Allopurinol protected for myocardial infarction (0.38, 0.17-0.83), hypertension (0.32, 0.18-0.58), TCE (0.48, 0.31 to 0.75, I = 55%) and serious TCE (0.56, 0.36 to 0.86, I = 44%). Meta-regression associated increasing dose of allopurinol with higher risk of TCE and serious TCE (P < 0.05). Accordingly, lower doses (≤ 300 mg/day) of allopurinol reduced the risk of TCE, unlike higher doses. Non-purine-like XOI did not significantly reduce or increase the risk of adverse CV events, but confidence intervals were wide. Quality of evidence was generally low to moderate.
CONCLUSIONS
Purine-like XOI may reduce the incidence of adverse CV outcomes. However, higher doses of allopurinol (> 300 mg/day) may be associated with loss of CV protection.
Topics: Cardiovascular Diseases; Dose-Response Relationship, Drug; Enzyme Inhibitors; Gout; Gout Suppressants; Humans; Incidence; Odds Ratio; Protective Factors; Randomized Controlled Trials as Topic; Risk Factors; Treatment Outcome; Xanthine Oxidase
PubMed: 29415653
DOI: 10.1186/s12872-018-0757-9 -
Journal of Cardiothoracic Surgery Jan 2019This systematic review was designed to evaluate the efficacy of remote ischemic conditioning (RIC) with primary percutaneous coronary intervention (PCI) versus primary... (Meta-Analysis)
Meta-Analysis
Remote ischemic conditioning during primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction: a systematic review and meta-analysis.
OBJECTIVE
This systematic review was designed to evaluate the efficacy of remote ischemic conditioning (RIC) with primary percutaneous coronary intervention (PCI) versus primary PCI alone for ST-segment elevation myocardial infarction (STEMI).
SEARCH STRATEGY
Computerized search for trials from PubMed, EMBASE, CENTRAL and Cochrane Database of Systematic Reviews databases.
SELECTION CRITERIA
Trials investigating RIC plus primary PCI (group A) versus primary PCI alone (group B).
OUTCOME MEASURES
Myocardial enzyme levels; left ventricular ejection fraction (LVEF); major adverse cardiac and cerebrovascular events (MACCEs); TIMI flow grade III; myocardial salvage index or infarct size per patients.
RESULTS
In all, 14 studies involving 3165 subjects were included. There was a significant association of myocardial edema levels, myocardial salvage index and incidence of MACCEs in group A compared with group B (myocardial edema levels: SMD = - 0.36, 95% CI (- 0.59, - 0.13); myocardial salvage index: MD = 0.06, 95% CI (0.02, 0.10); MACCE: OR = 0.70, 95% CI (0.57, 0.85)). With regard to infarct size, TIMI flow grade III and LVEF, group A appeared to be equivalent with group B (infarct size: MD = - 1.67, 95% CI (- 3.46, 0.11); TIMI flow grade III: OR = 1.04, 95% CI (0.71, 1.52); LVEF: MD = 0.74, 95% CI (- 0.80, 2.28)).
CONCLUSION
RIC was associated with lower myocardial edema levels, myocardial salvage index and incidence of MACCE, while non-significant beneficial effect on infarct size, TIMI flow grade III or LVEF. These findings suggest that RIC is a promising adjunctive treatment to PCI for the prevention of reperfusion injury in STEMI patients.
Topics: Humans; Ischemic Preconditioning; Myocardial Reperfusion Injury; Myocardium; Percutaneous Coronary Intervention; ST Elevation Myocardial Infarction; Ventricular Function, Left
PubMed: 30696461
DOI: 10.1186/s13019-019-0834-x -
World Journal of Cardiology Jun 2023ST-elevation myocardial infarction (STEMI) is the result of transmural ischemia of the myocardium and is associated with a high mortality rate. Primary percutaneous...
BACKGROUND
ST-elevation myocardial infarction (STEMI) is the result of transmural ischemia of the myocardium and is associated with a high mortality rate. Primary percutaneous coronary intervention (PPCI) is the recommended first-line treatment strategy for patients with STEMI. The timely delivery of PPCI became extremely challenging for STEMI patients during the coronavirus disease 2019 (COVID-19) pandemic, leading to a projected steep rise in mortality. These delays were overcome by the shift from first-line therapy and the development of modern fibrinolytic-based reperfusion. It is unclear whether fibrinolytic-based reperfusion therapy is effective in improving STEMI endpoints.
AIM
To determine the incidence of fibrinolytic therapy during the COVID-19 pandemic and its effects on STEMI clinical outcomes.
METHODS
PubMed, Google Scholar, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials were queried from January 2020 up to February 2022 to identify studies investigating the effect of fibrinolytic therapy on the prognostic outcome of STEMI patients during the pandemic. Primary outcomes were the incidence of fibrinolysis and the risk of all-cause mortality. Data were meta-analyzed using the random effects model to derive odds ratios (OR) and 95% confidence intervals. Quality assessment was carried out using the Newcastle-Ottawa scale.
RESULTS
Fourteen studies including 50136 STEMI patients ( = 15142 in the pandemic arm; = 34994 in the pre-pandemic arm) were included. The mean age was 61 years; 79% were male, 27% had type 2 diabetes, and 47% were smokers. Compared with the pre-pandemic period, there was a significantly increased overall incidence of fibrinolysis during the pandemic period [OR: 1.80 (1.18 to 2.75); = 78%; = 0.00; GRADE: Very low]. The incidence of fibrinolysis was not associated with the risk of all-cause mortality in any setting. The countries with a low-and middle-income status reported a higher incidence of fibrinolysis [OR: 5.16 (2.18 to 12.22); = 81%; = 0.00; GRADE: Very low] and an increased risk of all-cause mortality in STEMI patients [OR: 1.16 (1.03 to 1.30); = 0%; = 0.01; GRADE: Very low]. Meta-regression analysis showed a positive correlation of hyperlipidemia ( = 0.001) and hypertension ( < 0.001) with all-cause mortality.
CONCLUSION
There is an increased incidence of fibrinolysis during the pandemic period, but it has no effect on the risk of all-cause mortality. The low- and middle-income status has a significant impact on the all-cause mortality rate and the incidence of fibrinolysis.
PubMed: 37397830
DOI: 10.4330/wjc.v15.i6.309 -
Diabetologia Apr 2021Large cardiovascular outcome trials demonstrated that the cardioprotective effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors might reach beyond... (Meta-Analysis)
Meta-Analysis
AIMS/HYPOTHESIS
Large cardiovascular outcome trials demonstrated that the cardioprotective effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors might reach beyond glucose-lowering action. In this meta-analysis, we sought to evaluate the potential infarct size-modulating effect of SGLT2 inhibitors in preclinical studies.
METHODS
In this preregistered meta-analysis (PROSPERO: CRD42020189124), we included placebo-controlled, interventional studies of small and large animal models of myocardial ischaemia-reperfusion injury, testing the effect of SGLT2 inhibitor treatment on myocardial infarct size (percentage of area at risk or total area). Standardised mean differences (SMDs) were calculated and pooled using random-effects method. We evaluated heterogeneity by computing Τ and I values. Meta-regression was performed to explore prespecified subgroup differences according to experimental protocols and their contribution to heterogeneity was assessed (pseudo-R values).
RESULTS
We identified ten eligible publications, reporting 16 independent controlled comparisons on a total of 224 animals. Treatment with SGLT2 inhibitor significantly reduced myocardial infarct size compared with placebo (SMD = -1.30 [95% CI -1.79, -0.81], p < 0.00001), referring to a 33% [95% CI 20%, 47%] difference. Heterogeneity was moderate (Τ = 0.58, I = 60%). SGLT2 inhibitors were only effective when administered to the intact organ system, but not to isolated hearts (p interaction <0.001, adjusted pseudo-R = 47%). While acute administration significantly reduced infarct size, chronic treatment was superior (p interaction <0.001, adjusted pseudo-R = 85%). The medications significantly reduced infarct size in both diabetic and non-diabetic animals, favouring the former (p interaction = 0.030, adjusted pseudo-R = 12%). Treatment was equally effective in rats and mice, as well as in a porcine model. Individual study quality scores were not related to effect estimates (p = 0.33). The overall effect estimate remained large even after adjusting for severe forms of publication bias.
CONCLUSIONS/INTERPRETATION
The glucose-lowering SGLT2 inhibitors reduce myocardial infarct size in animal models independent of diabetes. Future in vivo studies should focus on clinical translation by exploring whether SGLT2 inhibitors limit infarct size in animals with relevant comorbidities, on top of loading doses of antiplatelet agents. Mechanistic studies should elucidate the potential relationship between the infarct size-lowering effect of SGLT2 inhibitors and the intact organ system.
Topics: Animals; Cardiovascular Agents; Disease Models, Animal; Myocardial Infarction; Myocardial Reperfusion Injury; Myocardium; Sodium-Glucose Transporter 2 Inhibitors; Translational Research, Biomedical
PubMed: 33483761
DOI: 10.1007/s00125-020-05359-2 -
Journal of Traditional Chinese Medicine... Feb 2024To evaluate the efficacy of electroacupuncture (EA) intervention on myocardial protection and postoperative rehabilitation in patients undergoing cardiac surgery with... (Meta-Analysis)
Meta-Analysis
Efficacy of electroacupuncture on myocardial protection and postoperative rehabilitation in patients undergoing cardiac surgery with cardiopulmonary bypass: a systematic review and Meta-analysis.
OBJECTIVE
To evaluate the efficacy of electroacupuncture (EA) intervention on myocardial protection and postoperative rehabilitation in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).
METHODS
Eight databases, including PubMed, Embase, the Cochrane Library, Web of Science, Chinese BioMedical Literature Database, China National Knowledge Infrastructure Database, Wanfang Data, China Science and Technology Journal Database, and two clinical trial registries, were searched. All randomized controlled trials (RCTs) related to EA intervention in cardiac surgery with CPB were collected. Based on the inclusion and exclusion criteria, two researchers independently screened articles and extracted data. After the quality evaluation, RevMan 5.3 software was used for analysis.
RESULTS
Fourteen RCTs involving 836 patients were included. Compared with the control treatment, EA significantly increased the incidence of cardiac automatic rebeat after aortic unclamping [relative risk () = 1.15, 95% confidence interval () (1.01, 1.31), 0.05; moderate]. Twenty-four hours after aortic unclamping, EA significantly increased the superoxide dismutase [standardized mean difference () = 0.96, 95% (0.32, 1.61), 0.05; low], and interleukin (IL)-2 [ = 1.33, 95% (0.19, 2.47), 0.05; very low] expression levels and decreased the malondialdehyde [ =-1.62, 95% (-2.15, -1.09), 0.05; moderate], tumour necrosis factor-α [ = -1.28, 95% (-2.37, -0.19), 0.05; moderate], and cardiac troponin I [SMD = -1.09, 95% (-1.85, -0.32), 0.05; low] expression levels as well as the inotrope scores [ = -0.77, 95% (-1.22, -0.31), 0.05; high]. There was no difference in IL-6 and IL-10 expression levels. The amount of intraoperative sedative [ = -0.31, 95% (-0.54, -0.09), 0.05; moderate] and opioid analgesic [ = -0.96, 95% (-1.53, -0.38), 0.05; low] medication was significantly lower in the EA group than in the control group. Moreover, the postoperative tracheal intubation time [ = -0.92, 95% (-1.40, -0.45), 0.05; low] and intensive care unit stay [ = -1.71, 95% (-3.06, -0.36), 0.05; low] were significantly shorter in the EA group than in the control group. There were no differences in the time to get out of bed for the first time, total days of antibiotic use after surgery, or postoperative hospital stay. No adverse reactions related to EA were reported in any of the included studies.
CONCLUSIONS
In cardiac surgery with CPB, EA may be a safe and effective strategy to reduce myocardial ischaemia-reperfusion injury and speed up the recovery of patients after surgery. These findings must be interpreted with caution, as most of the evidence was of low or moderate quality. More RCTs with larger sample sizes and higher quality are needed to provide more convincing evidence.
Topics: Humans; Cardiac Surgical Procedures; Cardiopulmonary Bypass; China; Electroacupuncture
PubMed: 38213234
DOI: 10.19852/j.cnki.jtcm.20230904.003 -
BMJ Open Dec 2023Whether the glucose-insulin-potassium (GIK) should be used as an adjuvant therapy for ischaemic myocardial disease remains controversial nowadays reperfusion era. This... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Whether the glucose-insulin-potassium (GIK) should be used as an adjuvant therapy for ischaemic myocardial disease remains controversial nowadays reperfusion era. This meta-analysis aimed to assess the effects of preinitiated GIK for patients undergoing planned percutaneous coronary intervention (PCI).
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
PubMed, Web of science, MEDLINE, Embase, Cochrane Library and ClinicalTrials.gov were searched through 27 November 2022.
ELIGIBILITY CRITERIA
Only randomised controlled trials involving participants preinitiated with GIK or placebo before planned PCI were included.
DATA EXTRACTION AND SYNTHESIS
Two independent reviewers used standardised methods to search, screen and code included trials. Risk of bias was assessed with the Cochrane tool. Pooled analysis was conducted using random or effects models according to the heterogeneity. Subgroup analyses were carried out for dosage of GIK and if with ongoing myocardial ischaemia.
RESULTS
13 randomised controlled trials (RCTs) including 3754 participants were evaluated. We found patients preconditioned with GIK before PCI showed a significant increase in Thrombolysis in Myocardial Infarction 3 flow events after angioplasty (OR 1.59, 95% CI 1.03 to 2.46, p=0.04), also revealed improved in-hospital left ventricular ejection fraction (weighed mean difference, WMD 1.62, 95% CI 0.21 to 3.03, p=0.02) and myocardial salvage index (WMD 0.09, 95% CI 0.01 to 0.16, p=0.03). Nevertheless, no benefit was observed in all-cause mortality neither on 30-day (OR 0.81, 95% CI 0.59 to 1.11, p=0.18) nor 6 months (OR 1.02, 95% CI 0.42 to 2.46, p=0.97). Furthermore, GIK intervention was associated with higher occurrences of complications such as phlebitis (OR 10.13, 95% CI 1.74 to 59.00, p=0.01) and hypoglycaemia (OR 10.43, 95% CI 1.32 to 82.29, p=0.03), but not hyperkalaemia (OR 9.36, 95% CI 0.50 to 175.27, p=0.13), liquid overload (OR 1.02, 95% CI 0.25 to 4.13, p=0.98) or in-hospital heart failure (OR 0.42, 95% CI 0.06 to 2.96, p=0.39).
CONCLUSIONS
Our study shows preconditioning GIK exhibits myocardial reperfusion and cardiac function benefits for patients planning to receive PCI intervention, while also some complications such as phlebitis and hypoglycaemia accompany.
PROSPERO REGISTRATION NUMBER
CRD42022326334.
Topics: Humans; Potassium; Percutaneous Coronary Intervention; Glucose; Hypoglycemia; Phlebitis; Insulins; Randomized Controlled Trials as Topic
PubMed: 38149412
DOI: 10.1136/bmjopen-2023-073557 -
Medicine Apr 2019In recent years, with the enormous advances in the field of cardiac intervention technology, the survival rate of patients with acute myocardial infarction (AMI) has...
The clinical efficacy and safety of the Chinese herbal medicine Astragalus (Huangqi) preparation for the treatment of acute myocardial infarction: A systematic review of randomized controlled trials.
BACKGROUND
In recent years, with the enormous advances in the field of cardiac intervention technology, the survival rate of patients with acute myocardial infarction (AMI) has been improved significantly. However, the risk of arrhythmias and heart failure remains very high in AMI patients for long-term prognosis. Chinese herbal medicine (CHM) is more and more used in the treatment of AMI because of its good curative effect and less side effects. The target of this research is to analyze the efficacy and safety of Astragalus (Huangqi) preparation in the treatment of AMI by meta-analysis and also to provide a better evidence for clinical practice.
METHODS
Seven databases will be searched in this study: The Cochrane Library, PubMed, Web of Science, the Chinese National Knowledge Infrastructure (CNKI), the Chinese Scientific Journal Database (CSJD), the Chinese Biomedical Literature Database (CBM), and Wanfang DATA. The following search terms will be used: (Huangqi OR Huang Qi OR Astragalus OR radix astragali) AND (acute myocardial infaction OR myocardial infaction OR AMI) AND (randomized controlled trial OR RCT OR randomized). No language limitations and the searches will be conducted up to March, 2019.
INCLUSION CRITERIA
randomized controlled trial (RCT) of Astragalus (Huangqi) preparation in patients with AMI. Main outcome measures will be left ventricular end systolic volume (LVESV), left ventricular end diastolic volume (LVEDV), left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI), recanalization rate, mortality rate, incidence of reperfusion arrhythmias, postinfarction angina pectoris, and re-infarction rate. Secondary outcome indicators were the incidence of adverse reactions and the effective rate of traditional Chinese medicine (TCM) treatment. Two independent reviewers will filter the literature and extract data which based to the Cochrane manual. The relevant data, including bias risk assessment, data synthesis, subgroup analysis, meta-analysis, and final meta-analysis, will be analyzed with RevMan 5.3 software. The funnel diagram will be used to evaluate the reported deviation, and the Egger test will be used to evaluate the symmetry of the funnel graph.
RESULTS
This systematic review study will provide a clear basis for evaluating the efficacy and safety of Astragalus (Huangqi) preparation with the treatment of AMI.
CONCLUSION
This study will provide an up-to-date evidence for evaluating the efficacy and safety of Astragalus (Huangqi) preparation.
PROSPERO REGISTRATION NUMBER
CRD42019124843.
Topics: Drugs, Chinese Herbal; Humans; Myocardial Infarction; Randomized Controlled Trials as Topic
PubMed: 31008964
DOI: 10.1097/MD.0000000000015256 -
Circulation Reports May 2022To achieve early reperfusion therapy for ST-elevation myocardial infarction (STEMI), proper and prompt patient transportation and activation of the catheterization... (Review)
Review
To achieve early reperfusion therapy for ST-elevation myocardial infarction (STEMI), proper and prompt patient transportation and activation of the catheterization laboratory are required. We investigated the efficacy of prehospital 12-lead electrocardiogram (ECG) acquisition and destination hospital notification in patients with STEMI. This is a systematic review of observational studies. We searched the PubMed database from inception to March 2020. Two reviewers independently performed literature selection. The critical outcome was short-term mortality. The important outcome was door-to-balloon (D2B) time. We used the GRADE approach to assess the certainty of the evidence. For the critical outcome, 14 studies with 29,365 patients were included in the meta-analysis. Short-term mortality was significantly lower in the group with prehospital 12-lead ECG acquisition and destination hospital notification than in the control group (odds ratio 0.72; 95% confidence interval [CI] 0.61-0.85; P<0.0001). For the important outcome, 10 studies with 2,947 patients were included in the meta-analysis. D2B time was significantly shorter in the group with prehospital 12-lead ECG acquisition and destination hospital notification than in the control group (mean difference -26.24; 95% CI -33.46, -19.02; P<0.0001). Prehospital 12-lead ECG acquisition and destination hospital notification is associated with lower short-term mortality and shorter D2B time than no ECG acquisition or no notification among patients with suspected STEMI outside of a hospital.
PubMed: 35600724
DOI: 10.1253/circrep.CR-22-0003 -
Thrombosis Journal Jul 2023Intracoronary (IC) administration of glycoprotein IIb/IIIa inhibitors (GPIs) has been studied as an adjunctive therapy to improve outcomes in patients with ST-segment...
Intracoronary versus intravenous glycoprotein IIb/IIIa inhibitors during primary percutaneous coronary intervention in patients with STEMI: a systematic review and meta-analysis.
BACKGROUND
Intracoronary (IC) administration of glycoprotein IIb/IIIa inhibitors (GPIs) has been studied as an adjunctive therapy to improve outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention. In this systematic review and meta-analysis, we aimed to evaluate the efficacy and safety of IC administration of GPIs compared with those of intravenous (IV) administration in patients with STEMI.
METHODS
We searched the MEDLINE, Embase, and Cochrane CENTRAL databases for relevant studies published before September 21, 2022. In total, 22 randomized controlled trials involving 7,699 patients were included.
RESULTS
The proportions of patients achieving thrombolysis in myocardial infarction grade 3 flow, myocardial blush grade 2/3, and complete ST-segment resolution were significantly higher in the IC group than in the IV group. Major adverse cardiac events (MACE) (RR: 0.54, 95% CI: 0.37-0.80) and heart failure (RR: 0.48, 95% CI: 0.25-0.91) within 1 month were significantly lower in the IC group than in the IV group; however, after 6 months, no difference was observed in MACE risk. Additionally, the risks of death and bleeding did not differ between the two routes of administration.
CONCLUSIONS
When considering adjunctive GPI administration for patients with STEMI, the IC route may offer greater benefits than the IV route in terms of myocardial reperfusion and reduced occurrence of MACE and heart failure within 1 month. Nonetheless, when making decisions for IC administration of GPIs, the absence of a benefit for bleeding risk and difficulty accessing the administration route should be considered.
PubMed: 37452333
DOI: 10.1186/s12959-023-00519-x -
Journal of the American Heart... Jun 2020Background We systematically reviewed trials comparing different reperfusion strategies for ST-segment-elevation myocardial infarction and used multivariate network... (Meta-Analysis)
Meta-Analysis
Background We systematically reviewed trials comparing different reperfusion strategies for ST-segment-elevation myocardial infarction and used multivariate network meta-analysis to compare outcomes across these strategies. Methods and Results We identified 31 contemporary trials in which patients with ST-segment-elevation myocardial infarction were randomized to ≥2 of the following strategies: fibrinolytic therapy (n=4212), primary percutaneous coronary intervention (PCI) (n=6139), or fibrinolysis followed by routine early PCI (n=5006). We categorized the last approach as "facilitated PCI" when the median time interval between fibrinolysis to PCI was <2 hours (n=2259) and as a "pharmacoinvasive approach" when this interval was ≥2 hours (n=2747). We evaluated outcomes of death, nonfatal reinfarction, stroke, and major bleeding using a multivariate network meta-analysis and a Bayesian analysis. Among the strategies evaluated, primary PCI was associated with the lowest risk of mortality, nonfatal reinfarction, and stroke. For mortality, primary PCI had an odds ratio of 0.73 (95% CI, 0.61-0.89) when compared with fibrinolytic therapy. Of the remaining strategies, the pharmacoinvasive approach was the next most favorable with an odds ratio for death of 0.79 (95% CI, 0.59-1.08) compared with fibrinolytic therapy. The Bayesian model indicated that when the 2 strategies examining routine early invasive therapy following fibrinolysis were directly compared, the probability of adverse outcomes was lower for the pharmacoinvasive approach relative to facilitated PCI. Conclusions A pharmacoinvasive approach is safer and more effective than facilitated PCI and fibrinolytic therapy alone. This has significant implications for ST-segment-elevation myocardial infarction care in settings where timely access to primary PCI, the preferred treatment for ST-segment-elevation myocardial infarction, is not available.
Topics: Combined Modality Therapy; Hemorrhage; Humans; Network Meta-Analysis; Percutaneous Coronary Intervention; Randomized Controlled Trials as Topic; Recurrence; Risk Assessment; Risk Factors; ST Elevation Myocardial Infarction; Stroke; Thrombolytic Therapy; Time Factors; Treatment Outcome
PubMed: 32500800
DOI: 10.1161/JAHA.119.015186