TY - JOUR
T1 - Pharmaco-Invasive Strategy Vs Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction in Latin America
T2 - A Meta-Analysis
AU - Diaz-Arocutipa, Carlos
AU - Vargas-Rivas, Cynthia
AU - Mendoza-Quispe, Daniel
AU - Benites-Moya, Cesar Joel
AU - Torres-Valencia, Javier
AU - Valenzuela-Rodriguez, German
AU - Gamarra-Valverde, Norma Nicole
AU - Chacon-Diaz, Manuel
AU - Costabel, Juan Pablo
AU - Mamas, Mamas A.
AU - Vicent, Lourdes
N1 - Publisher Copyright:
© 2024 The Authors
PY - 2025/1
Y1 - 2025/1
N2 - Background: Primary percutaneous coronary intervention (PCI) is the established treatment for ST-segment elevation myocardial infarction (STEMI), but often it is not readily available in low-resource settings. We assessed the safety and efficacy of the pharmaco-invasive strategy compared to primary PCI for STEMI in Latin America. Methods: MEDLINE, Embase, and Latin American and Caribbean Health Sciences Literature (LILACS) were searched for the period from their inception to September 2023, for studies that compared a pharmaco-invasive strategy vs primary PCI in Latin America. Primary outcomes were major adverse cardiovascular events and bleeding. Secondary outcomes were all-cause mortality, cardiovascular mortality, recurrent myocardial infarction, and stroke. Risk of bias was assessed using the Risk Of Bias In Non-randomized Studies—of Interventions (ROBINS-I) tool. Risk ratios (RRs) and 95% confidence intervals (CIs) from random-effects meta-analyses were reported. Results: Six cohort studies (n = 6621) were included; no clinical trials were found. The follow-up duration ranged from the in-hospital period to 1 year. Patients who underwent a pharmaco-invasive strategy (n = 841) vs a primary PCI (n = 5780) had similar rates of major adverse cardiovascular events (RR 0.82; 95% CI 0.59-1.16), major bleeding (RR 1.18; 95% CI 0.69-2.02), all-cause mortality (RR 0.70; 95% CI 0.47-1.05), cardiovascular mortality (RR 0.80; 95% CI 0.44-1.44), recurrent myocardial infarction (RR 0.54; 95% CI 0.18-1.61), and stroke (RR 1.27; 95% CI 0.17-9.73). Most studies had a serious (33%) or critical (50%) risk of bias. Conclusions: Among patients with STEMI in Latin America, only low-quality observational evidence indicated that cardiovascular outcomes and major bleeding rates were similar for those treated with a pharmaco-invasive strategy vs primary PCI. Randomized studies are needed in Latin America with the development of STEMI networks for better care.
AB - Background: Primary percutaneous coronary intervention (PCI) is the established treatment for ST-segment elevation myocardial infarction (STEMI), but often it is not readily available in low-resource settings. We assessed the safety and efficacy of the pharmaco-invasive strategy compared to primary PCI for STEMI in Latin America. Methods: MEDLINE, Embase, and Latin American and Caribbean Health Sciences Literature (LILACS) were searched for the period from their inception to September 2023, for studies that compared a pharmaco-invasive strategy vs primary PCI in Latin America. Primary outcomes were major adverse cardiovascular events and bleeding. Secondary outcomes were all-cause mortality, cardiovascular mortality, recurrent myocardial infarction, and stroke. Risk of bias was assessed using the Risk Of Bias In Non-randomized Studies—of Interventions (ROBINS-I) tool. Risk ratios (RRs) and 95% confidence intervals (CIs) from random-effects meta-analyses were reported. Results: Six cohort studies (n = 6621) were included; no clinical trials were found. The follow-up duration ranged from the in-hospital period to 1 year. Patients who underwent a pharmaco-invasive strategy (n = 841) vs a primary PCI (n = 5780) had similar rates of major adverse cardiovascular events (RR 0.82; 95% CI 0.59-1.16), major bleeding (RR 1.18; 95% CI 0.69-2.02), all-cause mortality (RR 0.70; 95% CI 0.47-1.05), cardiovascular mortality (RR 0.80; 95% CI 0.44-1.44), recurrent myocardial infarction (RR 0.54; 95% CI 0.18-1.61), and stroke (RR 1.27; 95% CI 0.17-9.73). Most studies had a serious (33%) or critical (50%) risk of bias. Conclusions: Among patients with STEMI in Latin America, only low-quality observational evidence indicated that cardiovascular outcomes and major bleeding rates were similar for those treated with a pharmaco-invasive strategy vs primary PCI. Randomized studies are needed in Latin America with the development of STEMI networks for better care.
UR - http://www.scopus.com/inward/record.url?scp=85211587017&partnerID=8YFLogxK
U2 - 10.1016/j.cjco.2024.10.005
DO - 10.1016/j.cjco.2024.10.005
M3 - Artículo de revisión
AN - SCOPUS:85211587017
SN - 2589-790X
VL - 7
SP - 78
EP - 87
JO - CJC Open
JF - CJC Open
IS - 1
ER -