Bleeding events associated with fibrinolytic therapy and primary percutaneous coronary intervention in patients with STEMI

Abstract

From the year 1986 onwards, several studies have been published focusing on the comparison between fibrinolysis and primary percutaneous coronary intervention (PPCI) in patients with ST segment elevated myocardial infarction (STEMI). However, because antiplatelet and anticoagulating medications are used in approximation, before and during these procedures, bleeding events have been reported to be associated with both reperfusion therapies. This study aimed to compare the bleeding events associated with fibrinolytic therapy and primary angioplasty in patients with STEMI. Randomized controlled trials (RCTs) comparing fibrinolysis and primary angioplasty in patients with STEMI were searched from Medline, PubMed, EMBASE, and the Cochrane databases. Bleeding complications following 30 days from hospitalization were considered as the primary clinical endpoints in this study. Secondary endpoints included all-cause mortality, re-infarction, stroke, and shock. Antiplatelet and anticoagulating drugs used during these 2 different procedures were compared. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated and the pooled analyses were performed with RevMan 5.3 software. Twelve studies involving 10 RCTs consisting of a total number of 5561 patients (2784 patients from the fibrinolysis group and 2777 patients from the PPCI group) were included in this meta-analysis. Our results showed no significant difference in the overall bleeding complications during a 30-day period between these 2 reperfusion therapies with OR 1.02; 95% CI 0.89 to 1.17, P = 0.78. Nonintracranial bleeding was also not statistically significant with OR 0.85; 95% CI 0.70 to 1.04, P = 0.12. However, fibrinolytic therapy was associated with a significantly higher rate of intracranial bleeding with OR 0.17; 95% CI 0.06 to 0.50, P = 0.001 than PPCI. In addition, death, re-infarction, and stroke significantly favored primary angioplasty. According to the results of this study, even if the rate of nonintracranial bleeding was not statistically significant between these 2 reperfusion therapies, fibrinolytic therapy was associated with a significantly higher rate of intracranial bleeding than PPCI. In addition, PPCI was associated with a significantly lower rate of death, reinfarction, and stroke. Therefore, PPCI should be recommended in patients with STEMI, especially in PCI-capable hospitals.

Incidence and clinical outcomes of bleeding complications and acute limb ischemia in STEMI and cardiogenic shock

“…Bleeding is a common complication in STEMI due to increase usage of thrombolytics, anticoagulation and antiplatelets and is one of the important clinical outcomes in acute coronary syndrome. [21][22][23][24] The overall risk of major bleeding in STEMI patients ranges between 2 and 10%. [25][26][27][28][29][30] In our study, we observed that the incidence of bleeding complications was 18.2%.…”

Cardiac mortality benefit of direct admission to percutaneous coronary intervention–capable hospital in acute myocardial infarction

“…Direct admission can decrease ongoing myocardial necrosis and reduce the risk with fibrinolysis therapy, leading to reduced cardiac mortality among patients with AMI. [ 16 – 18 ] However, the results of previous clinical trials showed equal cardiac mortality rates between direct PCH admission and inter-hospital transfer patients who underwent primary PCI within 120 minutes. [ 6 , 19 – 21 ] Other real-world data also reported similar results in cardiac mortality despite the shortened FDT.…”

Primary angioplasty and pharmaco-invasive strategies in the treatment of ST-elevated myocardial infarction

“…Однако не было выявлено различий между ТЛТ и первичной ЧКВ в общем числе геморрагических осложнений и во внемозговых кровотечениях в течение 30 сут. [23]. Таким образом, когда временной промежуток не позволяет произвести первичное ЧКВ, фармакоинвазивный подход является вполне приемлемой альтернативой.…”