Timing of invasive treatment after fibrinolysis in ST elevation myocardial infarction - A meta-analysis of immediate or early routine versus deferred or ischemia-guided randomised controlled trials

Context: Controversy remains over the optimal timing of percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) who have initially been treated with fibrinolytic agents. Objective: A meta-analysis of studies was performed comparing immediate or early angiography after fibrinolysis versus a more conservative strategy of deferred PCI or ischaemia-guided management. Data sources: MEDLINE, EMBASE, CENTRAL, ClinicalTrials.gov Study selection: Nine contemporary randomised controlled trials eligible for inclusion enrolling a total of 3325 patients were identified. Follow-up ranged between 1 and 12 months. Data extraction: Data were extracted by two independent reviewers using a standard form and cross-checked. Results: There was suggestive evidence for a reduction in the risk of total mortality in patients undergoing immediate or early PCI. There were no significant differences in the risk of stroke or major bleeding. Conclusions: These results support the current recommendation of a routine early invasive strategy in STEMI patients after successful fibrinolysis.