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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
2 days ago
Higher values of plasma aldosterone concentration (PAC) show a robust association with some metabolic variables, including triglycerides, urinary albumin excretion (UAE), carotid intima-media thickness (cIMT), worse ankle-brachial index (ABI) and major prevalence of carotid plaques, a recent study has shown.
24 Sep 2019
Obese patients are exposed to greater doses of radiation during radiofrequency ablation for atrial fibrillation, a recent study has found.
01 Oct 2019
Patients with greater ischaemia who underwent positron emission tomography (PET) myocardial perfusion imaging (MPI) have better survival with early revascularization, reports a study. Exploratory analyses reveal a lower threshold than that previously reported for single-photon emission computed tomography (SPECT).