Abstract 6242: Comparison of Facilitated and Primary Percutaneous Coronary Intervention: A Meta-Analysis
Background: Facilitated percutaneous coronary intervention (PCI), in which pharmacological agents are administered before coronary angiography, may result in early restoration of myocardial perfusion and can improve clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). To examine whether facilitated PCI is associated with better myocardial perfusion and clinical outcomes than primary PCI, we performed a meta-analysis of the clinical trials that compared the two strategies.
Methods: PubMed, EMBASE, and The Cochrane Collaboration databases were searched through June 2008. We included clinical trials that were published in English language peer-reviewed medical journals and randomized patients with STEMI to facilitated or primary PCI. Two investigators independently abstracted data. Random-effects model was used to pool results.
Results: Of the 419 identified articles, 24 were included (total patients =7997, facilitated PCI =4409, primary PCI =3588, median age=61 years, males=78%). Facilitated PCI increased myocardial perfusion as measured by grade 2 and/or 3 myocardial blush (588 vs. 468, OR=1.66, 95%CI=1.19 to 2.32) and ST segment resolution (1021 vs. 790, OR=1.61, 95%CI=1.25 to 2.09) as compared to primary PCI. Facilitated PCI was similar to primary PCI in reducing mortality (238 vs. 215, OR=1.10, 95%CI=0.88 to 1.37), reinfarction (129 vs. 109, OR=1.16, 95%CI=1.16(0.87 to 1.55), target vessel revascularization (181 vs. 144, OR=1.34, 95%CI=0.88 to 2.04), and stroke (51 vs. 24, OR=1.99, 95%CI=0.85 to 4.66). However, facilitated PCI was associated with increased incidence of major bleeding (236 vs. 151, OR=1.42, 95%CI=1.12, 1.81).
Conclusion: As compared to primary PCI, facilitated PCI is associated with early restoration of myocardial perfusion, but has no effect on overall mortality, reinfarction, target vessel revascularization, and stroke, and increases risk of major bleeding in patients with STEMI.