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Pharmacoinvasive therapy, PPCI confer comparable survival benefits to transfer STEMI patients

11 Sep 2018

Pharmacoinvasive therapy (PIT) and primary percutaneous coronary intervention (PPCI) are comparable in terms of all-cause mortality in transfer patients with ST-elevation myocardial infarction (STEMI), a recent meta-analysis has shown.

Seventeen studies were eligible for inclusion in the meta-analysis, of which six were randomized controlled trials (RCTs) and 11 were cohort studies. Together, the studies corresponded to 13.037 patients who received either PPCI (n=7,398) or PIT (n=5,693). No evidence of small study effects or publication bias was reported.

Pooled analysis of the six RCTs showed PIT and PPCI were statistically comparable in terms of all-cause, short-term (odds ratio [OR], 0.99; 95 percent CI, 0.73–1.34; p=0.93) and long-term (OR, 0.83; 0.59–1.17; p=0.287) mortality. On the other hand, PPCI significantly increased the risk of all-cause, short-term mortality, according to the pooled analysis of observational studies (OR, 1.39; 1.04–1.87; p=0.028).

However, combining both RCTs and observational studies demonstrated that both approaches resulted in similar likelihood of all-cause short-term (OR, 1.20; 0.97–1.49; p=0.099) and long-term (OR, 1.17; 0.84–1.62; p=0.361) mortality.

The same was true for total stroke (OR, 0.76; 0.51–1.49; p=0.193), haemorrhagic stroke (OR, 0.56; 0.20–1.62; p=0.288), ischaemic stroke (OR, 0.65; 0.28–1.49; p=0.310) and major bleeding (OR, 0.73; 0.48–1.11; p=0.138).

In contrast, PPCI significantly increased the risk of cardiogenic shock (OR, 1.48; 1.13–1.94; p=0.005) and decreased the chances of reinfarction (OR, 0.69; 0.49–0.97; p=0.033) relative to PIT.

The databases of Embase, Scopus, PubMed and the Cochrane Library were accessed for the present meta-analysis. Studies on facilitated PCI and with ischaemia-guided reperfusion were excluded. The Newcastle-Ottawa scale was used to evaluate study quality.

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Most Read Articles
5 days ago
Slideshow: Highlights from the Asian Pacific Society of Cardiology 2019 Congress
Tristan Manalac, 22 Nov 2018
Initial treatment with endovascular therapy results in better amputation-free survival in patients with critical limb ischaemia compared with open surgical bypass, according to a study presented at the American Heart Association Scientific Session 2018 (AHA 2018), held in Chicago, Illinois.
04 Jun 2019
The addition of alirocumab to intensive statin therapy appears to cut the risk of death following acute coronary syndrome, especially if treatment is sustained for at least 3 years, if baseline low-density lipoprotein cholesterol (LDL-C) is ≥100 mg/dL or if achieved LDL-C is low, according to data from the ODYSSEY OUTCOMES.
5 days ago
Use of aspirin for primary prevention of cardiovascular (CV) events leads to lower nonfatal ischaemic events but significantly greater nonfatal bleeding events, a recent study has shown.