Late myocardial reperfusion in ST-elevation myocardial infarction: protocol for a systematic review and meta-analysis
Rodrigo Vargas-Fernández1, Manuel Chacón-Diaz1,2, Gianfranco W Basualdo-Meléndez1
1Facultad de Ciencias de la Salud, Universidad Científica del Sur, Lima, Peru.
Insights
This study investigates late revascularization for ST-segment elevation myocardial infarction (STEMI) presenting after 12 hours. It compares outcomes like mortality and heart failure hospitalization with no late intervention to inform treatment guidelines.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- ST-segment elevation myocardial infarction (STEMI) is a severe acute myocardial infarction requiring timely reperfusion.
- A significant percentage of STEMI patients present late ( >12 hours after symptom onset).
- Optimal treatment strategies for late-presenting STEMI remain under investigation.
Purpose of the Study:
- To determine if late revascularization (12-72 hours post-symptom onset) impacts cardiovascular mortality in STEMI patients.
- To assess the effect of late revascularization on reinfarction, recurrent infarction, heart failure hospitalization, and post-infarction angina.
- To compare outcomes of late revascularization versus no late revascularization in STEMI patients with late presentation.
Main Methods:
- A systematic literature search will be conducted across major biomedical databases (PubMed, Embase, CINAHL, etc.).
- Inclusion criteria: adult STEMI patients undergoing primary percutaneous revascularization (PCI) between 12-72 hours post-symptom onset.
- Exclusion criteria: STEMI >12 hours with complications (heart failure, shock), other diagnoses, or pharmacoinvasive strategies. Risk of bias assessment and meta-analysis will be performed.
Main Results:
- This section is to be filled after the study is conducted and data is analyzed.
- The study aims to synthesize evidence on the clinical outcomes of late revascularization.
- Potential findings will inform clinical decision-making for late-presenting STEMI.
Conclusions:
- This systematic review and meta-analysis will evaluate the efficacy of late revascularization in STEMI.
- Findings will clarify the benefits and risks of intervening in STEMI patients presenting beyond the 12-hour window.
- The study will provide evidence-based recommendations for managing late-presenting STEMI.
Introduction:
ST-segment elevation myocardial infarction (STEMI) is the most severe clinical form of acute myocardial infarction, for which the current treatment consists of effective and timely myocardial reperfusion (within 12 hours of symptom onset). However, between 10% and 15% of patients with STEMI arrive at hospital facilities 12 hours after the onset of symptoms (late presentation). Therefore, the objective of the present study will be to determine if late revascularisation (12-72 hours after the onset of symptoms) affects the indicators of cardiovascular mortality, reinfarction, recurrent infarction, hospitalisation for heart failure and post infarction angina compared with no late revascularisation in patients with STEMI.
Methods And Analysis:
A systematic literature search of PubMed, The Cochrane Library, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, Scopus and Global Health will be conducted. Publications in English, Portuguese or Spanish that report the clinical results of primary percutaneous revascularisation (primary PCI) in adult patients with STEMI 12-72 hours after the onset of symptoms will be included. Studies with participants with a diagnosis other than STEMI or patients with STEMI of >12 hours complicated by heart failure, cardiogenic shock or ventricular arrhythmias, and studies of combined interventions (pharmacoinvasive strategy) were excluded. Two independent authors will identify the relevant publications, and discrepancies will be adjudicated by a third author. Data extraction will be performed by two independent authors and verified by a third author. Risk of bias of studies will be assessed using the Cochrane 'risk of bias' tool (RoB 2) or Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool. If appropriate, a meta-analysis will be performed in order to examine the effect of late revascularisation in clinical outcomes of interest.
Ethics And Discussion:
This study will use published data only, thus, ethical approval will not be required. The results will be disseminated through peer-reviewed publication and conference presentations.
Prospero Registration Number:
CRD42021283429.
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