title: Risks and Benefits of Thrombolytic, Antiplatelet, and Anticoagulant Therapies for ST Segment Elevation Myocardial Infarction: Systematic Review.
abstract: Objectives. Assess the impact of associating thrombolytics, anticoagulants, antiplatelets, and primary angioplasty (PA) on death, reinfarction (AMI), and major bleeding (MB) in STEMI therapy. Methods. Medline search was performed to identify randomized trials comparing these classes in STEMI treatment, at least 500 patients, providing death, AMI, and MB rates. Similar arms were grouped. Correlation between number of drugs and PA and the outcomes was evaluated, as well as correlation between the year of the study and the outcomes. Results. Fifty-nine papers remained after exclusions. 404.556 patients were divided into 35 groups of arms. There was correlation between the number of drugs and rates of death (r = -0.466, P = 0.005) and MB (r = 0.403, P = 0.016), confirmed by multivariate regression. This model also showed that PA is associated with lower mortality and increased MB. Year and period of publication correlated with the outcomes: death (r = -0.380, P < 0.001), MB (r = 0.212, P = 0.014), and AMI (r = -0.231, P = 0.009). Conclusion. The increasing complexity of STEMI treatment has resulted in significant reduction in mortality along with increased rates of MB. Overall, however, the benefits of treatment outweigh the associated risks of MB.
authors.affiliation: Serviço de Cardiologia e Cirurgia Cardiovascular, Hospital das Clínicas da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 110, Campus Saúde, 30130-100 Belo Horizonte, MG, Brazil ; Serviço de Hemodinâmca do Hospital Universitário São José (INCOR Minas), Rua Aimorés 2896, Barro Preto, 30140-073 Belo Horizonte, MG, Brazil ; Departamento de Clínica Médica da Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 190, Campus Saúde, 30130-100 Belo Horizonte, MG, Brazil.
authors.forename: Bruno Ramos
authors.initials: BR
authors.lastname: Nascimento
authors.affiliation: Serviço de Cardiologia e Cirurgia Cardiovascular, Hospital das Clínicas da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 110, Campus Saúde, 30130-100 Belo Horizonte, MG, Brazil.
authors.forename: Marcos Roberto
authors.initials: MR
authors.lastname: de Sousa
authors.affiliation: Departamento de Estatística, Instituto de Ciências Exatas, Universidade Federal de Minas Gerais, Avenida Antônio Carlos 6.627, Campus Pampulha, 31270-901 Belo Horizonte, MG, Brazil.
authors.forename: Fábio Nogueira
authors.initials: FN
authors.lastname: Demarqui
authors.affiliation: Serviço de Cardiologia e Cirurgia Cardiovascular, Hospital das Clínicas da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 110, Campus Saúde, 30130-100 Belo Horizonte, MG, Brazil ; Departamento de Clínica Médica da Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 190, Campus Saúde, 30130-100 Belo Horizonte, MG, Brazil.
authors.forename: Antonio Luiz Pinho
authors.initials: AL
authors.lastname: Ribeiro