| Objective To evaluate and compare the differences in theapeutic effects and safety between transfer for percutaneous coronary intervention and immediate intravenous thrombolysis fibrinolysis in acute myocardial infarction (AMI) . To find a more reasonable and effective strategies in reducing mortality and adverse cardiovascular events and improve the clinical prognosis of patients with AMI reperfusion therapy approach, and postoperative complications in the two treatment-related aspects were compared. Intended for some are not equipped with surgical equipment, cardiac catheterization, or does not have an independent physician to PCI hospitals select a reasonable treatment of reperfusion demonstration program, to provide the scientific basis for a better guide clinical treatment.Methods Correlative literature was searched by computer, which were chosen from The U.S. National Library of Medicine Internet Retrieval System (PubMed),MEDLINE,EMBASE,Blackwall,China HowNet (CNKI), Chinese Biomedical Database (CBM),while screening literature references, as well as manual retrieval of Chinese information published and unpublished, retrieval period from 2000 to January of 2009.Quality assessment of included studies was done by two reviewers independently. With the help of The Cochrane Collaboration's RevMan 4.2, The primary end point was the death,reinfarction and stroke in the Meta-analysis. Results We identified 4 clinical trials including 1589 patients.All of them have B level in quality. By combining analysis, we found that two groups of patients before treatment gender composition, age, risk factors (including smoking, drinking, obesity, lipids), complications (including diabetes, cerebrovascular disease, old myocardial infarction, hypertension), admission systolic blood pressure, heart rate, infarct location, Killip classification of cardiac function and no significant differences in age distribution and its distribution by age and sex composition are not significantly different (P> 0.05). 30d mortality difference was statistically significant. [OR = 0.59, 95% CI (0.41, 0.85) P = 0.005]. The two groups in the 30d of non-fatal reinfarction difference was statistically significant [OR = 0.37,95% CI (0.20,0.71) P = 0.003].The two groups in stroke (as defined in both newly issued last more than 24 hours and / or seriously affected the daily life of neurological deficit) rate on the difference between the two was statistically significant [OR = 0.17,95% CI (0.05, 0.58) P = 0.005], namely, the immediate transfer PCI group than in the thrombolysis group differences were statistically significant (P <0.05). According to the selected four articles,three groups showed major adverse cardiovascular events between the two groups major adverse cardiac events (MACE) are differences, Meta analysis revealed that this difference is more obvious (P <0.0001).Conclusion 1.Compared with immediate thrombolysis group, transfer PCI group have obvious advantages, infarct-related artery (infarct related artery IRA) recanalization rate, reaching TIMI-3 flow grade rate, can significantly improve the near-and far AMI patients of prognosis;2. Compared with the immediate group, transit PCI group can reduce the incidence of 30d mortality, reinfarction and stroke;3. Based on our study, treatment time window is important for patients with AMI onset, since the onset of symptoms from the opening of the blood in the 3h-12h-line as far as possible transfer of patients between the PCI, will be able to get a great clinical benefit. How to reduce the transit time in the early prime-time for thrombolysis is worthy of our focus on aspection.
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