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05:52
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 27, 2013
Routine early coronary angioplasty versus ischaemia-guided angioplasty after thrombolysis in acute ST-elevation
Savio P D'Souza1, Mamas A Mamas, Douglas G Fraser
1Manchester Heart Centre, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK.
European Heart Journal
|November 2, 2010
Summary
Routine early percutaneous coronary intervention (PCI) after thrombolysis for ST-elevation myocardial infarction significantly reduces re-infarction and ischemia. This strategy is safe and effective when primary PCI is not feasible.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Myocardial Infarction Management
Background:
- Prompt reperfusion is critical for survival in acute ST-segment elevation myocardial infarction (STEMI).
- Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy.
- Thrombolysis is an alternative when timely PCI is not achievable, with ongoing debate on subsequent routine early PCI versus ischemia-guided PCI.
Purpose of the Study:
- To compare the efficacy and safety of routine early PCI versus ischemia-guided PCI following thrombolysis in patients with STEMI.
- To meta-analyze existing randomized controlled trials evaluating these two interventional strategies.
Main Methods:
- A systematic literature search was conducted on MEDLINE and conference proceedings for randomized controlled trials.
- Eight trials involving 3195 patients were meta-analyzed using a random effects model.
- Outcomes assessed included 30-day mortality, re-infarction, and ischemia.
Main Results:
- Routine early PCI significantly reduced the combined endpoint of 30-day mortality, re-infarction, and ischemia compared to ischemia-guided PCI (7.3% vs 13.5%).
- The benefit was driven by significant reductions in re-infarction (OR 0.62) and ischemia (OR 0.21).
- No significant differences were observed in 30-day mortality or major bleeding rates between the two strategies.
Conclusions:
- Routine early PCI within 24 hours of thrombolysis is favored for STEMI patients when primary PCI is not feasible.
- This strategy is safe and associated with reduced rates of recurrent ischemia and re-infarction.
- Early PCI does not increase the risk of major hemorrhage.
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