| Aims: Early myocardial reperfusion therapy(<12 h)in patients with acute myocardial infarction(AMI)can significantly improve their prognosis.However,the effect of late reperfusion(>12 h)remains controversial.In this study,the effects of late reperfusion versus standard drug therapy on the outcomes of patients with AMI were evaluated by systematic review and meta-analysis.Methods: Pub Med,Embase,Medline,Cochrane,Wanfang,and CNKI databases were searched for eligible studies for the present study.Meta-analysis was performed using Rev Man 5.3.3 software.Relative risk(RR)and the95% confidence interval(CI)were used to compare the outcomes between the two groups.The main outcome measures were major adverse cardiac events(MACEs),all-cause mortality,recurrent myocardial infarction(MI),and heart failure.Results: We identified18 studies including 14677 patients,of whom 5157 received late reperfusion with percutaneous coronary intervention(PCI)and 9520 received medication therapy(MT).Compared to MT,late PCI was associated with decreased all-cause mortality(RR: 0.60,95% CI: 0.44-0.83;P=0.002),MACEs(RR: 0.67;95% CI: 0.50-0.89;P<0.001),and heart failure(RR: 0.76;95% CI: 0.60-0.97;P=0.03),while there was also a trend toward decreased recurrent MI(RR: 0.70;95% CI: 0.47-1.05;P=0.08).However,subgroup analysis according to time to PCI showed that the clinical benefit was only from PCI after12 h but not from 2-60 days of the onset of symptoms.Conclusions-The present meta-analysis suggested that PCI performed >12 h but not 2-60 days after AMI is associated with significant improvement in clinical outcomes.However,our results needfurther rigorously designed large-sample-size clinical trials to be validated. |
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