Available data suggest that thrombolytic therapy facilitated percutaneous coronary intervention (FPCI) is not beneficial, and recent analyses have shown a correlation between mortality risk and outcomes of patients with ST elevation myocardial infarctions treated with FPCI. The aim of this study was to analyze the impact of the mortality risk on the survival benefit of primary percutaneous coronary intervention (PPCI) compared to FPCI. A total of 13 trials enrolling 5,789 patients were pooled for analyses. PPCI survival benefit was calculated as the 30-day mortality after FPCI minus the 30-day mortality after PPCI, and the mortality rate of FPCI was interpreted as a proxy for mortality risk. A weighted metaregression was used to test the relation between mortality risk and explanatory variables. A fixed-effect linear regression analysis modeling the log odds ratio (PPCI/FPCI) as a linear function of the log odds of FPCI mortality was used to estimate the mortality risk that nullified the 30-day survival benefit of PPCI over FPCI. Across all studies, the absolute survival benefit ranged from −5.6 (favoring FPCI) to +7.2 (favoring PPCI). According to the slope of the regression line (−0.7, x-axis intercept −2.1) for the patients with baseline mortality risk > 4.2%, it is unlikely to obtain a survival benefit by FPCI compared to PPCI. In conclusion, the higher the mortality risk of patients with ST elevation myocardial infarctions, the higher the likelihood of a survival advantage of PPCI over FPCI. Recent post hoc analyses of the Facilitated Intervention With Enhanced Reperfusion Speed to Stop Events` (FINESSE) trial have shown a favorable interaction between risk and the outcomes of patients with ST elevation myocardial infarctions (STEMIs) treated with facilitated percutaneous coronary intervention (FPCI).1 In contrast, a recent subanalysis of the Assessment of the Safety and Efficacy of a New Treatment Strategy with Percutaneous Coronary Intervention (ASSENT-4) study showed the benefit of FPCI in case of short prehospital delays, but not in high-risk patients.2 Thus, we aimed in the present study to analyze whether mortality risk affects the survival benefit of primary percutaneous coronary intervention (PPCI) compared to FPCI.

Comparison of impact of mortality risk on the survival benefit of primary percutaneous coronary intervention versus facilitated percutaneous coronary intervention.

TARANTINI, GIUSEPPE;FRIGO, ANNA CHIARA;
2011

Abstract

Available data suggest that thrombolytic therapy facilitated percutaneous coronary intervention (FPCI) is not beneficial, and recent analyses have shown a correlation between mortality risk and outcomes of patients with ST elevation myocardial infarctions treated with FPCI. The aim of this study was to analyze the impact of the mortality risk on the survival benefit of primary percutaneous coronary intervention (PPCI) compared to FPCI. A total of 13 trials enrolling 5,789 patients were pooled for analyses. PPCI survival benefit was calculated as the 30-day mortality after FPCI minus the 30-day mortality after PPCI, and the mortality rate of FPCI was interpreted as a proxy for mortality risk. A weighted metaregression was used to test the relation between mortality risk and explanatory variables. A fixed-effect linear regression analysis modeling the log odds ratio (PPCI/FPCI) as a linear function of the log odds of FPCI mortality was used to estimate the mortality risk that nullified the 30-day survival benefit of PPCI over FPCI. Across all studies, the absolute survival benefit ranged from −5.6 (favoring FPCI) to +7.2 (favoring PPCI). According to the slope of the regression line (−0.7, x-axis intercept −2.1) for the patients with baseline mortality risk > 4.2%, it is unlikely to obtain a survival benefit by FPCI compared to PPCI. In conclusion, the higher the mortality risk of patients with ST elevation myocardial infarctions, the higher the likelihood of a survival advantage of PPCI over FPCI. Recent post hoc analyses of the Facilitated Intervention With Enhanced Reperfusion Speed to Stop Events` (FINESSE) trial have shown a favorable interaction between risk and the outcomes of patients with ST elevation myocardial infarctions (STEMIs) treated with facilitated percutaneous coronary intervention (FPCI).1 In contrast, a recent subanalysis of the Assessment of the Safety and Efficacy of a New Treatment Strategy with Percutaneous Coronary Intervention (ASSENT-4) study showed the benefit of FPCI in case of short prehospital delays, but not in high-risk patients.2 Thus, we aimed in the present study to analyze whether mortality risk affects the survival benefit of primary percutaneous coronary intervention (PPCI) compared to FPCI.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11577/2441787
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