Abstract

BACKGROUND: Early myocardial reperfusion therapy (< 12 h) in patients with acute myocardial infarc­tion (AMI) can significantly improve their prognosis. However, the effect of late reperfusion (> 12 h) remains controversial. In this study, the effects of late reperfusion versus standard drug therapy on the outcomes of patients with AMI were evaluated by systematic review and meta-analysis.
METHODS: PubMed, Embase, Medline, Cochrane, Wanfang, and CNKI databases were searched for eligible studies for the present study. Meta-analysis was performed using RevMan 5.3.3 software. Rela­tive risk (RR) and the 95% confidence interval (CI) were used to compare the outcomes between the two groups. The main outcome measures were major adverse cardiac events (MACEs), all-cause mortality, recurrent myocardial infarction (MI), and heart failure.
RESULTS: Eighteen studies were identified including 14,677 patients, of whom 5157 received late reperfusion with percutaneous coronary intervention (PCI) and 9520 received medication therapy (MT). Compared to MT, late PCI was associated with decreased all-cause mortality (RR 0.60, 95% CI 0.44–0.83; p = 0.002), MACEs (RR 0.67; 95% CI 0.50–0.89; p < 0.001), and heart failure (RR 0.76; 95% CI 0.60–0.97; p = 0.03), while there was also a trend toward decreased recurrent MI (RR 0.70; 95% CI 0.47–1.05; p = 0.08). However, subgroup analysis according to time to PCI showed that the clinical benefit was only from PCI after 12 h but not from 2 to 60 days of the onset of symptoms.
CONCLUSIONS: The present meta-analysis suggested that PCI performed > 12 h but not 2–60 days after AMI is associated with significant improvement in clinical outcomes. However, these results need further rigorously designed large sample size clinical trials to be validated.

Details

Title
Invasive reperfusion after 12 hours of the symptom onset remains beneficial in patients with ST-segment elevation myocardial infarction: Evidence from a meta-analysis of published data
Author
Yang, Hai-Tao 1 ; Xiu, Wen-Juan 1 ; Zheng, Ying-Ying 1 ; Liu, Fen 2 ; Gao, Ying 3 ; Ma, Xiang 1 ; Yang, Yi-Ning 1 ; Li, Xiao-Mei 1 ; Ma, Yi-Tong 1 ; Xie, Xiang 4 

 First Affiliated Hospital of Xinjiang mendical Univer sity, Urumqi, Xinjiang, China 
 Laboratory of Coronary Heart Disease, Xinjiang Key Laboratory of Cardiovascular Diseases Research, Urumqi, Xinjiang, China 
 Department of Cadre Ward, First Affiliated Hospital of Xinjiang Medical Univer sity, Urumqi, Xinjiang, China 
 First Affiliated Hospital of Xinjiang mendical Univer sity, Urumqi, Xinjiang, China. [email protected] 
First page
333
End page
342
Publication year
2019
Publication date
2019
Publisher
Wydawnictwo Via Medica
ISSN
18975593
e-ISSN
1898018X
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2464206244
Copyright
© 2019. This work is published under https://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.