Prehospital Facilitated Intervention As A Potential "Sally Port" For The Rescue Of Acute St-Segment Elevation Myocardial Infarction: A Meta-Analysis

Background: Early reperfusion in ST-segment elevation myocardial infarction (STEMI) is associated with improved clinical outcomes. The purpose of this study was to characterize the benefits and risks of prehospital fibrinolysis with timely percutaneous coronary intervention (PCI) as a promising strategy which could reduce the reperfusion delay especially for the patients in remote areas. Methods: We identified clinical trials comparing the facilitated PCI versus primary PCI and divided them into two subgroups (prehospital treatment and in-hospital treatment). Results: We identified eighteen clinical trials involving 11118 patients. The facilitated PCI had higher rates of initial TIMI grade 3 flow compared with the primary PCI (44.6% vs 18.8%, P<0.01). Facilitated PCI with prehospital fibrinolysis was associated with lower incidences of cardiogenic shock (3.8% vs 5.7%, P=0.02), potential lower incidences of short-term mortality (4.3% vs 4.3%, P=0.94), heart failure (6.9% vs 8.3%, P=0.20) and major bleeding (2.4% vs 3.6%; P=0.06), and higher rates of urgent target vessel revascularization (5.2% vs 2.5%, P=0.0002) and total stroke (1.3% vs 0.4%, P=0.009) compared with primary PCI. Facilitated PCI with in-hospital fibrinolysis led to increased incidences of non-fatal reinfarction (3.4% vs 1.8%, P=0.0004) and total stroke (1.2% vs 0.4%, P=0.002), and potential risks for short-term death (4.5% vs 3.5%, P=0.10), cardiogenic shock (5.3% vs 4.7%, P=0.61), urgent target vessel revascularization (4.4% vs 3.5%, P=0.18), and major bleeding (5.8% vs 4.3%, P=0.11) compared with primary PCI. Conclusions: Facilitated PCI with prehospital fibrinolysis offered potential benefits over primary PCI for the treatment of STEMI, in spite of a slight increased risk of total stroke.