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Early routine percutaneous coronary intervention after fibrinolysis vs. standard therapy in ST-segment elevation

Francesco Borgia1, Shaun G Goodman, Sigrun Halvorsen

  • 1Royal Brompton Hospital and Imperial College, London, UK.

European Heart Journal
|July 6, 2010
PubMed

Insights

Early percutaneous coronary intervention (PCI) after fibrinolysis in ST-segment elevation myocardial infarction (STEMI) patients significantly reduces reinfarction and ischemia. This strategy offers sustained benefits up to 12 months without increasing bleeding risks.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials

Background:

  • ST-segment elevation myocardial infarction (STEMI) management often involves fibrinolysis followed by reperfusion strategies.
  • The role of early routine percutaneous coronary intervention (PCI) after fibrinolysis compared to standard therapy (rescue PCI) remains a focus of research.
  • Previous trials have suggested benefits but lacked statistical power for hard endpoints.

Purpose of the Study:

  • To conduct a meta-analysis of randomized controlled trials (RCTs) evaluating early routine PCI versus standard therapy in STEMI patients treated with fibrinolysis.
  • To define the clinical and safety benefits of early PCI on hard endpoints and other relevant outcomes.
  • To assess the long-term efficacy and safety of early PCI post-fibrinolysis.

Main Methods:

  • A meta-analysis was performed on seven eligible randomized controlled trials.
  • A total of 2961 patients with STEMI who received fibrinolysis were included.
  • Outcomes analyzed included death, reinfarction, recurrent ischemia, major bleeding, and stroke at 30 days and 6-12 months.

Main Results:

  • Early PCI after fibrinolysis significantly reduced reinfarction (OR: 0.55) and recurrent ischemia (OR: 0.25) at 30 days.
  • The combined endpoint of death/reinfarction was also significantly reduced (OR: 0.65).
  • These benefits were maintained at 6-12 months, with significant reductions in reinfarction (OR: 0.64) and death/reinfarction (OR: 0.71), without increased major bleeding or stroke.

Conclusions:

  • Early routine PCI following fibrinolysis in STEMI patients is associated with a significant reduction in reinfarction and recurrent ischemia at one month.
  • The observed benefits of early PCI persist up to 6-12 months post-hospitalization.
  • This strategy does not lead to a significant increase in adverse bleeding events or stroke compared to standard therapy.
Abstract

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