A Meta Analysis Of Facilitated PCI In Acute Myocardial Infarction To Evaluat The Optimal Timing Of Intervene

Background:ST-segment elevation myocardial infarction is one of the leading causes of death in patients with cardiovascular diseases.The key to the treatment and prognosis of STEMI is to open the occlusion of the coronary artery as early as possible and to reperfuse of infarct myocardium in a lasting and effective way in order to save the most ischemic injury myocardium as far as possible and improve patients ‘ outcomes and reduce mortality.Intravenous thrombolysis and percutaneous coronary intervention is commonly used in clinical treatment of STEMI.Both have their own advantages and disadvantages.Early intervention after thrombolysis,that is facilitated PCI,refers to give reduced-dose thrombolytics and/or platelet GpIIb/IIIa receptor antagonis before PCI,which can not only make up for the shortcomings of low patency rate and many complications of thrombolysis but also make time for transit for patients.A large number of studies have confirmed the safety and efficacy of facilitated PCI is not inferior to primary PCI.However,there is still a lack of META analysis for the best time to intervene after thrombolytic therapy.This article systemically investigates the best opportunity of routine intervention after thrombolysis through the analysis of safety and effectiveness.objectives:Collect randomized controlled trials(RCTs)of intervention after thrombolytic therapy in STEMI patients.A meta—analysis and systemic review was conducted to investigate the safety and efficacy of intervention after thrombolytic therapy used inpatients with STEMI to analyze the optimal timing of intervention after thrombolysis? Methods:RCTs concluding routine intervention after thrombolysis in STEMI patients were searched.To compare the interval between thrombolysis and intervention,the groups whose interval are less than 3h are selected to the(0-3h)subgroup and the groups whose interval range from 3h to 6h are selected to the(3-6h)subgroup and the rests are classed as(6-24h)subgroup.The data of our study include all cause deaths rate,myocardial infarction rate,revascularization rate,TIMI flow grade 3 rate,cardiogenic shock rate,congestive heart failure rate,major bleeding events rate,stroke rate.The STATA 12.0 for meta analysis is the software applied in this study.Results:Up to Feb 10,2016,16 RCTs were included in our meta-analysis.4697 patients were enrolled,with 2209 patients in subgroup(0-3h)and 1192 patients in subgroup(3-6h)and 1286 patients in subgroup(6-24h).There are hardly differences in all cause deaths rate,in-hospital major bleeding events rate,myocardial infarction rate,revascularization rate,cardiogenic shock rate in the patients suffered from STEMI treated with FPCI in 3 subgroups.But 30 days major and minor bleeding events rate is much more higher in subgroup(0-3h)than in subgroup(3-24h).Subgroup(3-6h)has the lowest stroke rate and lowest congestive heart failure rate,whereas subgroup(6-24h)gains the highest stroke rate.Similarly,Subgroup(3-6h)has the highest rate of TIMI III flow degree.Conclusions:The optimal timing is three to six hours between thrombolysis and intervention,but which is supposed to be comfirmed by more clinical research.