Consistency of benefit from an early invasive strategy after fibrinolysis: a patient-level meta-analysis

被引：13

作者：

Abdel-Qadir, Husam ^{[1
,2
,3
]}

Yan, Andrew T. ^{[1
,4
]}

Tan, Mary ^{[5
]}

Borgia, Francesco ^{[6
]}

Piscione, Federico ^{[7
]}

Di Mario, Carlo ^{[8
,9
]}

Halvorsen, Sigrun ^{[10
]}

Cantor, Warren J. ^{[1
,11
]}

Westerhout, Cynthia M. ^{[12
]}

Scheller, Bruno ^{[13
]}

Le May, Michel R. ^{[14
]}

Fernandez-Aviles, Francisco ^{[15
]}

Sanchez, Pedro L. ^{[16
]}

Lee, Douglas S. ^{[1
,17
]}

Goodman, Shaun G. ^{[1
,4
,5
,12
]}

机构：

[1] Univ Toronto, Dept Med, Toronto, ON, Canada

[2] Univ Toronto, Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada

[3] Womens Coll Hosp, Div Cardiol, Toronto, ON, Canada

[4] St Michaels Hosp, Terrence Donnelly Heart Ctr, Div Cardiol, Toronto, ON M5B 1W8, Canada

[5] Canadian Heart Res Ctr, Toronto, ON, Canada

[6] Univ Naples Federico II, Naples, Italy

[7] Univ Salerno, Univ Hosp San Giovanni di Dio & Ruggi dAragona, I-84100 Salerno, Italy

[8] Royal Brompton Hosp, NIHR Cardiovasc BRU, London SW3 6LY, England

[9] NHLI Imperial Coll, London, England

[10] Oslo Univ Hosp Ulleval, Oslo, Norway

[11] Southlake Reg Hlth Ctr, Newmarket, ON, Canada

[12] Univ Alberta, Canadian VIGOUR Ctr, Edmonton, AB, Canada

[13] Univ Saarland, Innere Med 3, Homburg, Germany

[14] Univ Ottawa, Inst Heart, Ottawa, ON, Canada

[15] Hosp Gen Univ Gregorio Maranon, Madrid, Spain

[16] Hosp Univ Salamanca IBSAL, Salamanca, Spain

[17] Toronto Gen Hosp, Univ Hlth Network, Div Cardiol, Toronto, ON, Canada

来源：

HEART | 2015年 / 101卷 / 19期

基金：

加拿大健康研究院;

关键词：

ACUTE MYOCARDIAL-INFARCTION; EARLY REVASCULARIZATION; CORONARY INTERVENTION; GENDER-DIFFERENCES; MANAGEMENT; THROMBOLYSIS; ANGIOPLASTY; MORTALITY; OUTCOMES; INSIGHTS;

D O I：

10.1136/heartjnl-2015-307815

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background Randomised controlled trials have demonstrated improved outcomes with an early invasive strategy compared with routine care after fibrinolysis among patients with ST-elevation myocardial infarction. However, it remains uncertain whether specific patient subsets derive differential benefit from an early invasive strategy. Methods Using patient-level data from seven randomised trials, we studied the relationship between treatment assignment (early invasive vs standard care) and adverse cardiovascular events. The outcomes assessed were death/reinfarction at 30 days and at 1 year, as well as death/reinfarction/recurrent ischaemia, major bleeding and stroke at 30 days. The analyses were conducted in strata (age, sex, diabetes, prior infarction, Killip class, anterior infarction and time from symptom onset to fibrinolysis) to assess for an interaction between the stratifying variable and treatment assigned. Results There were 101 deaths and 115 recurrent infarctions at 30 days in 3010 patients. There were no strata where an invasive strategy conferred a differential treatment effect. With the exception of a marginally significant interaction between Killip class and treatment for death/reinfarction at 30 days and 1 year (p values for interaction 0.044 and 0.038, respectively), no interactions between the stratifying variables and treatment assignment were observed. Conclusions Benefit from an early invasive strategy after fibrinolysis for ST-elevation myocardial infarction is similar across patient subgroups stratified by these clinical characteristics. Therefore, prediction of risk and benefit from an early invasive strategy after fibrinolysis for ST-elevation myocardial infarction is best achieved by global risk evaluation rather than specific patient characteristics.

引用

页码：1554 / +

页数：8

共 24 条

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