Pharmaco-Invasive Strategy Vs Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction in Latin America: A Meta-Analysis

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.