Comparison of Reperfusion Strategies for ST‐Segment–Elevation Myocardial Infarction: A Multivariate Network Meta‐analysis

Author:

Fazel Reza1ORCID,Joseph Timothy I.2,Sankardas Mullasari A.3,Pinto Duane S.4,Yeh Robert W.4,Kumbhani Dharam J.5,Nallamothu Brahmajee K.67

Affiliation:

1. Division of Cardiovascular Medicine Department of Medicine Beth Israel Deaconess Medical Center Boston MA

2. Department of Cardiovascular Medicine Mayo Clinic Rochester MN

3. Department of Cardiology Institute of Cardiovascular Diseases The Madras Medical Mission Chennai India

4. Department of Medicine Smith Center for Outcomes Research in Cardiology Beth Israel Deaconess Medical Center Boston MA

5. Division of Cardiology Department of Medicine UT Southwestern Medical Center Dallas TX

6. Veterans Affairs Ann Arbor Health Services Research and Development Center of Excellence Ann Arbor Veterans Affairs Medical Center Ann Arbor MI

7. Division of Cardiovascular Medicine Department of Internal Medicine University of Michigan Medical School Ann Arbor MI

Abstract

Background We systematically reviewed trials comparing different reperfusion strategies for ST‐segment–elevation myocardial infarction and used multivariate network meta‐analysis to compare outcomes across these strategies. Methods and Results We identified 31 contemporary trials in which patients with ST‐segment–elevation myocardial infarction were randomized to ≥2 of the following strategies: fibrinolytic therapy (n=4212), primary percutaneous coronary intervention ( PCI ) (n=6139), or fibrinolysis followed by routine early PCI (n=5006). We categorized the last approach as “facilitated PCI ” when the median time interval between fibrinolysis to PCI was <2 hours (n=2259) and as a “pharmacoinvasive approach” when this interval was ≥2 hours (n=2747). We evaluated outcomes of death, nonfatal reinfarction, stroke, and major bleeding using a multivariate network meta‐analysis and a Bayesian analysis. Among the strategies evaluated, primary PCI was associated with the lowest risk of mortality, nonfatal reinfarction, and stroke. For mortality, primary PCI had an odds ratio of 0.73 (95% CI , 0.61–0.89) when compared with fibrinolytic therapy. Of the remaining strategies, the pharmacoinvasive approach was the next most favorable with an odds ratio for death of 0.79 (95% CI , 0.59–1.08) compared with fibrinolytic therapy. The Bayesian model indicated that when the 2 strategies examining routine early invasive therapy following fibrinolysis were directly compared, the probability of adverse outcomes was lower for the pharmacoinvasive approach relative to facilitated PCI . Conclusions A pharmacoinvasive approach is safer and more effective than facilitated PCI and fibrinolytic therapy alone. This has significant implications for ST‐segment–elevation myocardial infarction care in settings where timely access to primary PCI , the preferred treatment for ST‐segment–elevation myocardial infarction , is not available.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

Cited by 40 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3