Clinical InvestigationAcute Ischemic Heart DiseaseAn early invasive strategy versus ischemia-guided management after fibrinolytic therapy for ST-segment elevation myocardial infarction: A meta-analysis of contemporary randomized controlled trials
Section snippets
Data sources
Relevant published studies were identified through a computerized literature search of the Cochrane library, Embase, and Medline electronic databases from January 1950 to February 2007, using the key words angioplasty, stent, myocardial infarction, thrombolytic therapy, and fibrinolytic therapy (Figure 1). In addition, bibliographies of journal articles and relevant reviews were extensively hand-searched to locate additional studies.
Study selection
Two investigators (H.C.W., J.J.Y.) independently evaluated
Study selection
The process of study selection and exclusion is outlined in Figure 1. We found 20 relevant articles of which we excluded 1 study that assessed only intracoronary fibrinolytic therapy10 and 1 study of combination half-dose fibrinolytic therapy with a glycoprotein GpIIb/IIIa receptor (Gp2b/3a) inhibitor.11 Of the remaining articles, there were 13 randomized trials of balloon angioplasty12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24 and 5 contemporary PCI trials.25, 26, 27, 28, 29 All of the
Discussion
In this systematic review of contemporary treatment strategies among STEMI patients treated with fibrinolytic therapy, we found that an early invasive strategy was associated with significant reductions in the risk of death and reinfarction, as compared to a strategy of ischemia-guided management. Furthermore, we did not find a significantly increased risk of stroke or major bleeding associated with an early invasive strategy; however, given that the CIs around these safety estimates were
References (34)
- et al.
Temporal trends in the treatment of over 1.5 million patients with myocardial infarction in the US from 1990 through 1999: the National Registry of Myocardial Infarction 1, 2 and 3
J Am Coll Cardiol
(2000) - et al.
Practice variation and missed opportunities for reperfusion in ST-segment-elevation myocardial infarction: findings from the Global Registry of Acute Coronary Events (GRACE)
Lancet
(2002) - et al.
Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials
Lancet
(2003) - et al.
Percutaneous coronary intervention after fibrinolysis: a multiple meta-analyses approach according to the type of strategy
J Am Coll Cardiol
(2006) - et al.
2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines
J Am Coll Cardiol
(2008) - et al.
2007 focused update of the ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice guidelines
J Am Coll Cardiol
(2008) - et al.
Age and the utilization of cardiac catheterization following uncomplicated first acute myocardial infarction treated with thrombolytic therapy (The Second National Registry of Myocardial Infarction [NRMI-2])
Am J Cardiol
(2001) - et al.
Assessing the quality of reports of randomized clinical trials: is blinding necessary
Control Clin Trials
(1996) - et al.
Percutaneous transluminal coronary angioplasty after thrombolytic therapy: a prospective controlled randomized trial
J Am Coll Cardiol
(1986) - et al.
Randomized controlled trial of late in-hospital angiography and angioplasty versus conservative management after treatment with recombinant tissue-type plasminogen activator in acute myocardial infarction
Am J Cardiol
(1990)
Relation between flow grade after thrombolytic therapy and the effect of angioplasty on left ventricular function: a prospective randomized trial
Am Heart J
Thrombolysis with tissue plasminogen activator in acute myocardial infarction: no additional benefit from immediate percutaneous coronary angioplasty
Lancet
Routine invasive strategy within 24 hours of thrombolysis versus ischaemia-guided conservative approach for acute myocardial infarction with ST-segment elevation (GRACIA-1): a randomised controlled trial
Lancet
Combined angioplasty and pharmacological intervention versus thrombolysis alone in acute myocardial infarction (CAPITAL AMI study)
J Am Coll Cardiol
Beneficial effects of immediate stenting after thrombolysis in acute myocardial infarction
J Am Coll Cardiol
Comparison of primary and facilitated percutaneous coronary interventions for ST-elevation myocardial infarction: quantitative review of randomised trials
Lancet
Incidence, predictors, and prognostic implications of bleeding and blood transfusion following percutaneous coronary interventions
Am J Cardiol
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Are cardiovascular trial results systematically different between North America and Europe? A study based on intra-meta-analysis comparisons
2015, Archives of Cardiovascular DiseasesCitation Excerpt :For meta-analyses with non-fatal endpoints, there are 23 such overlapping meta-analyses [17,19,20,26–28,30–33,35,38–41,43–50]. Therefore, there are 18 meta-analyses with fatal endpoints [49–66] and 21 meta-analyses with non-fatal endpoints [15,22,25,42,52–55,57,59,61–64,66–72] that are non-overlapping in the sense just outlined. In terms of what was in each case the most commonly reported fatal endpoint, there are 28 meta-analyses where, relative to the control, the intervention is more favoured in Europe than North America, 15 meta-analyses where the intervention is more favoured in North America than Europe and four meta-analyses where the intervention and control groups were not identified (i.e. one treatment group was simply compared with another treatment group).
Outcomes of a pharmacoinvasive strategy for successful versus failed fibrinolysis and primary percutaneous intervention in acute myocardial infarction (from the strategic reperfusion early after myocardial infarction [STREAM] study)
2014, American Journal of CardiologyCitation Excerpt :Incorporation of this ECG metric into clinical STEMI guidelines as an additional prognostic measure deserves consideration.5 After failure of reperfusion with fibrinolysis, previous studies have shown that rescue PCI results in a reduction in death, reinfarction, and CHF at 6 months from 41.0% to 29.2% (p <0.001) compared with conservative care.13,14 In the Rescue Angioplasty versus Conservative Therapy of Repeat Thrombolysis trial, rescue PCI conducted approximately 4.6 hours after fibrinolysis achieved a 53% reduction (hazard ratio 0.47, 95% CI 0.28 to 0.79) in 6-month death, reinfarction, cerebrovascular event, or severe CHF.14
ST-segment elevation myocardial infarction
2012, Cardiovascular Therapeutics: A Companion to Braunwald's Heart Disease: Fourth EditionAlmanac 2011: Acute coronary syndromes. The national society journals present selected research that has driven recent advances in clinical cardiology
2012, Egyptian Heart JournalCitation Excerpt :The availability of potent ADP P2Y12 receptor blockers has raised further concerns about bleeding complications, and it was gratifying, therefore, that the PLATO trial substudy confirmed that event rates could be reduced with ticagrelor compared with clopidogrel without an increase in bleeding risk.70,71 The role of invasive treatment after fibrinolytic treatment in STEMI has been clarified in two recent meta-analyses of small and medium-size trials comparing strategies of routine early angiography for all patients with deferred or ischaemia-guided angiography.72,73 Both meta-analyses reported that routine early angiography was associated with reductions in the rates of recurrent myocardial infarction and death and this strategy is now recommended in international guidelines.
Almanac 2011: Acute coronary syndromes. The national society journals present selected research that has driven recent advances in clinical cardiology
2012, Revista Portuguesa de CardiologiaCitation Excerpt :The availability of potent ADP P2Y12 receptor blockers has raised further concerns about bleeding complications, and it was gratifying, therefore that the PLATO trial substudy confirmed that event rates could be reduced with ticagrelor compared with clopidogrel without an increase in bleeding risk.70,71 The role of invasive treatment after fibrinolytic treatment in STEMI has been clarified in two recent meta-analysis of small and medium-size trials comparing strategies of routine early angiography for all patients with deferred or ischaemia-guided angiography.72,73 Both meta-analyses reported that routine early angiography was associated with reductions in the rates of recurrent myocardial infarction and death and this strategy is now recommended in international guidelines.
In-Hospital Outcomes of a Regional ST-Segment Elevation Myocardial Infarction Acute Transfer and Repatriation Program
2011, Canadian Journal of Cardiology
Dr. Wijeysundera is supported by a University of Toronto, Department of Medicine Clinician Scientist Training Program, and a research fellowship award from the Canadian Institute of Health Research (CIHR) (Ottawa, Ontario, Canada). Dr. You is supported by a McMaster University Department of Medicine Internal Career Research Award. Dr. Ko is supported by a Heart and Stroke Foundation of Ontario Clinician Scientist Award. This project is funded in part by a CIHR operating grant.
Dr. Warren Cantor has received consulting fees, speaker's honoraria, and unrestricted research grants from Hoffman La Roche Canada (Montreal, Quebec, Canada).