Thrombolysis in the age of primary percutaneous coronary intervention: Review and meta-analysis of early PCI

IntroductionPrimary percutaneous coronary intervention (PCI) is only available for minority of patients with ST segment elevation myocardial infarction in acute care hospitals in Saudi Arabia. Early PCI has evolved from facilitated PCI but with more delayed timing from thrombolysis to PCI (needle to balloon time). Previous metanalyses proved the effectiveness of early PCI but they were contaminated by inclusion of facilitated PCI trials. Our metanalysis enroll clinical trails of early PCI only to estimate the effectiveness and determine the needle to balloon time.MethodsMEDLINE search in English language from 1990 to March 2012 of randomized control trials of early PCI was performed. All included clinical trials compared early PCI to standard medical therapy. We excluded clinical trials that used early PCI when primary PCI feasible. Statistical analysis was performed using the Review Manager 5. Odds ratio (OR) random-effect model and 95% confidence intervals (CIs) were used as summary statistics.ResultsFive randomized trials of Early PCI only met the inclusion criteria. Early PCI is associated with improved cardiovascular events with no significant bleeding complications. There is minimal clinical heterogeneity and insignificant statistical heterogeneity (I2=12.6%, p=0.33) among the five randomized control trials. The median time for needle to balloon is 4h.ConclusionEarly PCI should be incorporated in the treatment of all ST-segment elevation myocardial infarction. The median time for needle to balloon is 4h