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The effects of fibrinolytic before referring STEMI patients: A systematic review and meta-analysis

Pajaree Mongkhon1, Piyameth Dilokthornsakul2, Kanokkorn Tepwang1

  • 1Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.

International Journal of Cardiology. Heart & Vasculature
|June 16, 2017
PubMed

Insights

Pre-referral fibrinolytic injection for ST-elevation myocardial infarction (STEMI) patients does not reduce major adverse cardiac events. This treatment may increase the risk of major bleeding, suggesting careful consideration before use.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Clinical Trials

Background:

  • Primary percutaneous coronary intervention (PCI) accessibility is limited for ST-elevation myocardial infarction (STEMI) patients in primary care.
  • Timely referral to PCI-capable hospitals is crucial but may increase cardiac events.
  • The efficacy of pre-referral fibrinolytic injection in STEMI patients has not been systematically evaluated.

Purpose of the Study:

  • To systematically review the effect of fibrinolytic injection before referring STEMI patients to PCI-capable settings.
  • To evaluate the impact of pre-referral fibrinolysis on major adverse cardiac events (MACEs) and mortality.

Main Methods:

  • Systematic literature search of Embase, Cochrane CENTRAL, Google Scholar, and PubMed.
  • Inclusion of studies comparing fibrinolytic injection versus no injection in STEMI patients presented to non-PCI-capable settings.
  • Meta-analysis using a random-effect model to assess the primary outcome of 30-day MACEs.

Main Results:

  • Three RCTs and three non-RCTs were included.
  • Fibrinolytic injection did not significantly decrease MACEs (RR 1.18; 95% CI, 0.89-1.57).
  • No reduction in mortality, re-infarction, or ischemic stroke was observed; however, major bleeding risk increased.

Conclusions:

  • Pre-referral fibrinolytic injection offers no clinical benefit for STEMI patients in non-PCI-capable settings.
  • This approach is associated with an increased risk of major bleeding.
  • Clinicians should carefully consider the use of fibrinolytic injection in STEMI patients prior to referral.
Abstract

Keywords:
Coronary artery diseaseFibrinolyticNon PCI-capable settingsPercutaneous coronary interventionST-segment elevation myocardial infarction

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