title: [A meta-analysis of early percutaneous coronary intervention within 24 hours of thrombolysis in acute ST-elevation myocardial infarction].
abstract: OBJECTIVE
  To evaluate the efficacy and safety of early percutaneous coronary intervention (PCI) within 24 hours of thrombolysis in acute ST-elevation myocardial infarction.
  
  
  METHODS
  The databases of Medline, EMBASE, Elsevier, Cochrane library, Wanfang and CNKI were searched for randomized controlled trials. Quality assessment and data extraction were performed by two independent reviewers. Statistical analyses were conducted with Stata 10.0 and RevMan 5.0 software.
  
  
  RESULTS
  Eight studies (NORDI-STEMI, TRANSFER-AMI, WEST, CARESS-AMI, CAPITAL-AMI, GRACIA-I, SIAMI III & PRAGUE-I) involving a total of 3157 patients fulfilled the inclusion criteria. Meta-analysis results showed that, as compared with the control group, (1) the combined endpoint of 30 day mortality, re-infarction and ischemia was significantly lower in early PCI within 24 h of thrombolysis group [relative risk (RR) = 0.52, 95% confidence interval (CI) 0.42 - 0.65, P < 0.001]; (2) 30-day re-infarction decreased in early PCI within 24 h of thrombolysis group (RR = 0.57, 95%CI 0.40 - 0.81, P = 0.002); (3) 30-day ischemia had a significant reduction in early PCI within 24 h of thrombolysis group (RR = 0.27, 95%CI 0.14 - 0.52, P < 0.001); (4) 30-day major hemorrhage or mortality rates were not significantly different between two groups (RR = 1.07, 95%CI 0.78-1.46, P = 0.69; RR = 0.86, 95%CI 0.62 - 1.20, P = 0.38 respectively).
  
  
  CONCLUSIONS
  When primary PCI is not feasible, our meta-analysis favors early PCI within 24 h of thrombolysis for acute ST-elevation myocardial infarction. Early PCI is associated with a lowered recurrence of major adverse cardiac events, ischemia and re-infarction. But there is no elevated risk of major hemorrhage and mortality.
authors.affiliation: Department of Cardiology, Tongji University School of Medicine, Shanghai, China.
authors.forename: Bu-chun
authors.initials: BC
authors.lastname: Zhang
authors.forename: Zhi-wen
authors.initials: ZW
authors.lastname: Zhou
authors.forename: Lei
authors.initials: L
authors.lastname: Hou
authors.forename: Ji
authors.initials: J
authors.lastname: Zhang
authors.forename: Wei-ming
authors.initials: WM
authors.lastname: Li
authors.forename: Ya-wei
authors.initials: YW
authors.lastname: Xu
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D006801:Humans; D009203:Myocardial Infarction / Q000503:physiopathology* / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D015912:Thrombolytic Therapy