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Timing of invasive treatment after fibrinolysis in ST elevation myocardial infarction – a meta-analysis of immediate or early routine versus deferred or ischemia-guided randomised controlled trials
  1. Steffen Desch1,
  2. Ingo Eitel1,
  3. Kazem Rahimi2,
  4. Suzanne de Waha1,
  5. Gerhard Schuler1,
  6. Holger Thiele1
  1. 1University of Leipzig Heart Centre, Department of Internal Medicine/Cardiology, Leipzig, Germany
  2. 2Cardiology Department, John Radcliffe Hospital, Oxford, UK
  1. Correspondence to Holger Thiele, University of Leipzig Heart Centre, Department of Internal Medicine/Cardiology, Strümpellstr. 39, Leipzig 04289, Germany; thielh{at}medizin.uni-leipzig.de

Abstract

Context Controversy remains over the optimal timing of percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) who have initially been treated with fibrinolytic agents.

Objective A meta-analysis of studies was performed comparing immediate or early angiography after fibrinolysis versus a more conservative strategy of deferred PCI or ischaemia-guided management.

Data sources MEDLINE, EMBASE, CENTRAL, ClinicalTrials.gov

Study selection Nine contemporary randomised controlled trials eligible for inclusion enrolling a total of 3325 patients were identified. Follow-up ranged between 1 and 12 months.

Data extraction Data were extracted by two independent reviewers using a standard form and cross-checked.

Results There was suggestive evidence for a reduction in the risk of total mortality in patients undergoing immediate or early PCI. There were no significant differences in the risk of stroke or major bleeding.

Conclusions These results support the current recommendation of a routine early invasive strategy in STEMI patients after successful fibrinolysis.

  • Myocardial infarction
  • percutaneous coronary intervention
  • fibrinolysis
  • meta-analysis
  • STEMI
  • thrombolysis

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Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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