Diaz-Arocutipa Carlos, Vargas-Rivas Cynthia, Mendoza-Quispe Daniel, Benites-Moya Cesar Joel, Torres-Valencia Javier, Valenzuela-Rodriguez German, Gamarra-Valverde Norma Nicole, Chacon-Diaz Manuel, Costabel Juan Pablo, Mamas Mamas A, Vicent Lourdes
Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru.
Service of Cardiology, Hospital II Huaraz, Ancash, Peru.
CJC Open. 2024 Oct 11;7(1):78-87. doi: 10.1016/j.cjco.2024.10.005. eCollection 2025 Jan.
Primary percutaneous coronary intervention (PCI) is the established treatment for ST-segment elevation myocardial infarction (STEMI), but often it is not readily available in low-resource settings. We assessed the safety and efficacy of the pharmaco-invasive strategy compared to primary PCI for STEMI in Latin America.
MEDLINE, Embase, and Latin American and Caribbean Health Sciences Literature (LILACS) were searched for the period from their inception to September 2023, for studies that compared a pharmaco-invasive strategy vs primary PCI in Latin America. Primary outcomes were major adverse cardiovascular events and bleeding. Secondary outcomes were all-cause mortality, cardiovascular mortality, recurrent myocardial infarction, and stroke. Risk of bias was assessed using the Risk Of Bias In Non-randomized Studies-of Interventions (ROBINS-I) tool. Risk ratios (RRs) and 95% confidence intervals (CIs) from random-effects meta-analyses were reported.
Six cohort studies (n = 6621) were included; no clinical trials were found. The follow-up duration ranged from the in-hospital period to 1 year. Patients who underwent a pharmaco-invasive strategy (n = 841) vs a primary PCI (n = 5780) had similar rates of major adverse cardiovascular events (RR 0.82; 95% CI 0.59-1.16), major bleeding (RR 1.18; 95% CI 0.69-2.02), all-cause mortality (RR 0.70; 95% CI 0.47-1.05), cardiovascular mortality (RR 0.80; 95% CI 0.44-1.44), recurrent myocardial infarction (RR 0.54; 95% CI 0.18-1.61), and stroke (RR 1.27; 95% CI 0.17-9.73). Most studies had a serious (33%) or critical (50%) risk of bias.
Among patients with STEMI in Latin America, only low-quality observational evidence indicated that cardiovascular outcomes and major bleeding rates were similar for those treated with a pharmaco-invasive strategy vs primary PCI. Randomized studies are needed in Latin America with the development of STEMI networks for better care.
直接经皮冠状动脉介入治疗（PCI）是ST段抬高型心肌梗死（STEMI）的既定治疗方法，但在资源匮乏地区往往难以获得。我们评估了在拉丁美洲，与直接PCI相比，药物介入策略治疗STEMI的安全性和有效性。
检索MEDLINE、Embase以及拉丁美洲和加勒比地区健康科学文献数据库（LILACS）自建库至2023年9月期间，比较拉丁美洲药物介入策略与直接PCI的研究。主要结局为主要不良心血管事件和出血。次要结局为全因死亡率、心血管死亡率、再发心肌梗死和卒中。使用干预性非随机研究的偏倚风险（ROBINS-I）工具评估偏倚风险。报告随机效应荟萃分析的风险比（RR）和95%置信区间（CI）。
纳入六项队列研究（n = 6621）；未发现临床试验。随访时间从住院期至1年。接受药物介入策略治疗的患者（n = 841）与接受直接PCI治疗的患者（n = 5780）相比，主要不良心血管事件发生率（RR 0.82；95% CI 0.59 - 1.16）、大出血发生率（RR 1.18；95% CI 0.69 - 2.02）、全因死亡率（RR 0.70；95% CI 0.47 - 1.05）、心血管死亡率（RR 0.80；95% CI 0.44 - 1.44）、再发心肌梗死发生率（RR 0.54；95% CI 0.18 - 1.61）和卒中发生率（RR 1.27；95% CI 0.17 - 9.73）相似。大多数研究存在严重（33%）或关键（50%）偏倚风险。
在拉丁美洲的STEMI患者中，仅有低质量的观察性证据表明，药物介入策略治疗与直接PCI治疗的心血管结局和大出血发生率相似。随着STEMI网络的发展，拉丁美洲需要进行随机研究以提供更好的治疗。
