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Effect of fibrinolytic therapy on ST-elevation myocardial infarction clinical outcomes during the COVID-19 pandemic: A systematic review and meta-analysis.
Khedr, Anwar; Hennawi, Hussam Al; Khan, Muhammed Khuzzaim; Elbanna, Mostafa; Jama, Abbas B; Proskuriakova, Ekaterina; Mushtaq, Hisham; Mir, Mikael; Boike, Sydney; Rauf, Ibtisam; Eissa, Aalaa; Urtecho, Meritxell; Koritala, Thoyaja; Jain, Nitesh; Goyal, Lokesh; Surani, Salim; Khan, Syed A.
Afiliação
  • Khedr A; Department of Internal Medicine, BronxCare Health System, Bronx, NY 10457, United States.
  • Hennawi HA; Department of Internal Medicine, Jefferson Abington Hospital, Abington, PA 19001, United States.
  • Khan MK; Department of Internal Medicine, Dow University of Health Science, Karachi 74200, Pakistan.
  • Elbanna M; Department of Internal Medicine, Rochester Regional Health, Rochester, NY 14621, United States.
  • Jama AB; Department of Critical Care, Mayo Clinic Health System, Mankato, MN 56001, United States.
  • Proskuriakova E; Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL 60608, United States.
  • Mushtaq H; Department of Internal Medicine, St. Vincent's Medical Center, Bridgeport, CT 06606, United States.
  • Mir M; Department of Medicine, University of Minnesota, Minneapolis, MN 55455, United States.
  • Boike S; Department of Medicine, University of Minnesota, Minneapolis, MN 55455, United States.
  • Rauf I; Department of Medicine, St. George's University, School of Medicine, St George SW17 0RE, Grenada.
  • Eissa A; Department of Medicine, KFS University, KFS 33511, Egypt.
  • Urtecho M; Department of Medicine, Robert D and Patricia E. Kern Center of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, United States.
  • Koritala T; Department of Hospital Medicine, Mayo Clinic Health System, Mankato, MN 56001, United States.
  • Jain N; Department of Medicine, Mayo Clinic Health System, Mankato, MN 56001, United States.
  • Goyal L; Department of Hospital Medicine, Christus Sphon Hospital-shoreline, Corpus Christo, TX 78404, United States.
  • Surani S; Department of Pulmonary, Critical Care & Sleep Medicine, Texas A&M University, College Station, TX 77843, United States. srsurani@hotmail.com.
  • Khan SA; Department of Critical Care Medicine, Mayo Clinic Health System, Mankato, MN 56001, United States.
World J Cardiol ; 15(6): 309-323, 2023 Jun 26.
Article em En | MEDLINE | ID: mdl-37397830
ABSTRACT

BACKGROUND:

ST-elevation myocardial infarction (STEMI) is the result of transmural ischemia of the myocardium and is associated with a high mortality rate. Primary percutaneous coronary intervention (PPCI) is the recommended first-line treatment strategy for patients with STEMI. The timely delivery of PPCI became extremely challenging for STEMI patients during the coronavirus disease 2019 (COVID-19) pandemic, leading to a projected steep rise in mortality. These delays were overcome by the shift from first-line therapy and the development of modern fibrinolytic-based reperfusion. It is unclear whether fibrinolytic-based reperfusion therapy is effective in improving STEMI endpoints.

AIM:

To determine the incidence of fibrinolytic therapy during the COVID-19 pandemic and its effects on STEMI clinical outcomes.

METHODS:

PubMed, Google Scholar, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials were queried from January 2020 up to February 2022 to identify studies investigating the effect of fibrinolytic therapy on the prognostic outcome of STEMI patients during the pandemic. Primary outcomes were the incidence of fibrinolysis and the risk of all-cause mortality. Data were meta-analyzed using the random effects model to derive odds ratios (OR) and 95% confidence intervals. Quality assessment was carried out using the Newcastle-Ottawa scale.

RESULTS:

Fourteen studies including 50136 STEMI patients (n = 15142 in the pandemic arm; n = 34994 in the pre-pandemic arm) were included. The mean age was 61 years; 79% were male, 27% had type 2 diabetes, and 47% were smokers. Compared with the pre-pandemic period, there was a significantly increased overall incidence of fibrinolysis during the pandemic period [OR 1.80 (1.18 to 2.75); I2= 78%; P = 0.00; GRADE Very low]. The incidence of fibrinolysis was not associated with the risk of all-cause mortality in any setting. The countries with a low-and middle-income status reported a higher incidence of fibrinolysis [OR 5.16 (2.18 to 12.22); I2 = 81%; P = 0.00; GRADE Very low] and an increased risk of all-cause mortality in STEMI patients [OR 1.16 (1.03 to 1.30); I2 = 0%; P = 0.01; GRADE Very low]. Meta-regression analysis showed a positive correlation of hyperlipidemia (P = 0.001) and hypertension (P < 0.001) with all-cause mortality.

CONCLUSION:

There is an increased incidence of fibrinolysis during the pandemic period, but it has no effect on the risk of all-cause mortality. The low- and middle-income status has a significant impact on the all-cause mortality rate and the incidence of fibrinolysis.
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Texto completo: 1 Base de dados: MEDLINE Idioma: En Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Idioma: En Ano de publicação: 2023 Tipo de documento: Article