Pharmaco-Invasive Strategy Vs Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial...

Area of Science:

• Cardiology
• Interventional Cardiology
• Public Health

Background:

• Primary percutaneous coronary intervention (PCI) is the standard treatment for ST-segment elevation myocardial infarction (STEMI).
• Access to primary PCI is limited in low-resource settings, particularly in Latin America.
• The pharmaco-invasive strategy offers an alternative when primary PCI is unavailable.

Purpose of the Study:

• To compare the safety and efficacy of the pharmaco-invasive strategy versus primary PCI for STEMI in Latin America.
• To evaluate key cardiovascular outcomes and bleeding events associated with each strategy.
• To synthesize existing evidence from observational studies in the region.

Main Methods:

• A systematic literature search was conducted across MEDLINE, Embase, and LILACS up to September 2023.
• Included studies compared pharmaco-invasive strategy to primary PCI in Latin America.
• Random-effects meta-analyses were performed to calculate risk ratios (RRs) and 95% confidence intervals (CIs) for primary and secondary outcomes, with risk of bias assessed using ROBINS-I.

Main Results:

• Six cohort studies (n=6621) were included; no randomized trials were identified.
• No significant differences were observed between the pharmaco-invasive strategy and primary PCI in major adverse cardiovascular events (RR 0.82; 95% CI 0.59-1.16) or major bleeding (RR 1.18; 95% CI 0.69-2.02).
• Rates of all-cause mortality, cardiovascular mortality, recurrent myocardial infarction, and stroke were also similar, though confidence intervals were wide. Most studies exhibited serious or critical risk of bias.

Conclusions:

• Low-quality observational evidence suggests similar cardiovascular outcomes and bleeding rates between pharmaco-invasive strategy and primary PCI for STEMI in Latin America.
• The findings highlight the need for high-quality randomized controlled trials in Latin America.
• Development of STEMI networks is crucial for improving patient care and facilitating robust research in the region.