META-analysis Of The Effect Of Different Timing Of PCI On The Prognosis Of STEMI Patients

Objective:This meta-analysis collected literatures on the effect of different timing of PCI on the prognosis of patients with acute ST-segment elevation myocardial infarction(STEMI),compared the efficacy and safety of different stent implantation time in STEMI patients,and explored the beneficial time window for PCI.Methods:Chinese and foreign databases including CNKI,VIP,Wanfang,clinical trial registries,CBM,Pub Med,Cochrane Library,and Embase were searched for literatures on the effects of different timing of PCI on patients published before August 2020.The time between symptom onset and stent implantation was less than 12 h and greater than12 h,respectively,as direct PCI group and delayed PCI group.The delayed PCI group was used as the observation group and divided into 12 to 24h group,12 to 48 h group,48 h to 7 days group,> 7 days group and other subgroups.For major adverse cardiovascular events(MACE)including cardiac death again,TVR,heart failure,myocardial infarction,the incidence of major events such as bleeding,stroke as the main outcome indicators,to perioperative events including slow blood flow o reflow,distal embolism is the incidence of adverse events,such as secondary outcome,as the efficacy and safety evaluation index respectively.Literature screening,quality evaluation,and data extraction were conducted independently by the two institutes.Meta-analysis was performed with Rev Man 5.3 software,and the effect size of outcome indicators was represented by OR and 95%CI.Results:1、Three RCTs and seven non-randomized controlled studies were included for Meta analysis,including 4319 STEMI patients,2773 in the direct PCI group and 1546 in the delayed PCI group.After literature search,it was found that there were few literatures in the elective group lasting 48 h to 7 days and their quality was not high,so the combination of the 12-48 h group and the 12-72 h group was carried out for systematic evaluation.After subgroup analysis,there were 343 patients in the 12-24 h group,3187 patients in the 12-72 h group,and 401 patients in the 7-day > group.2、Compared with elective PCI,direct PCI in the 12-24 h group significantly reduced the incidence of MACE events[OR(95%CI)=0.47(0.28,0.80),P=0.005],but there was no significant difference in the incidence of perioperative complications.3、There was no significant difference in MACE events and perioperative events between the direct PCI group and the elective PCI group at 12-72 h.4、The > 7-day delayed PCI significantly reduced the incidence of MACE events [OR(95%CI)=3.38(1.73,6.63),P=0.0004] and perioperative events [OR(95%CI)=6.73(2.73,16.62),P < 0.0001].Conclusions:1.For patients with acute STEMI,there was no significant difference in the incidence of MACE events between PCI delayed to 72 hours and emergency PCI,but there was insufficient evidence to evaluate long-term cardiac function differences.2.In STEMI patients with high Thrombus burden,Delays of more than 7 days after stent implantation may reduce perioperative complications.