Effect of fibrinolytic therapy on ST-elevation myocardial infarction clinical outcomes during the COVID-19 pandemic:A systematic review and meta-analysis  

作　　者：Anwar Khedr Hussam Al Hennawi Muhammed Khuzzaim Khan Mostafa Elbanna Abbas B Jama Ekaterina Proskuriakova Hisham Mushtaq Mikael Mir Sydney Boike Ibtisam Rauf Aalaa Eissa Meritxell Urtecho Thoyaja Koritala Nitesh Jain Lokesh Goyal Salim Surani Syed A Khan 

机构地区：[1]Department of Internal Medicine,BronxCare Health System,Bronx,NY 10457,United States [2]Department of Internal Medicine,Jefferson Abington Hospital,Abington,PA 19001,United States [3]Department of Internal Medicine,Dow University of Health Science,Karachi 74200,Pakistan [4]Department of Internal Medicine,Rochester Regional Health,Rochester,NY 14621,United States [5]Department of Critical Care,Mayo Clinic Health System,Mankato,MN 56001,United States [6]Department of Internal Medicine,Mount Sinai Hospital,Chicago,IL 60608,United States [7]Department of Internal Medicine,St.Vincent's Medical Center,Bridgeport,CT 06606,United States [8]Department of Medicine,University of Minnesota,Minneapolis,MN 55455,United States [9]Department of Medicine,St.George's University,School of Medicine,St George SW170RE,Grenada [10]Department of Medicine,KFS University,KFS 33511,Egypt [11]Department of Medicine,Robert D and Patricia E.Kern Center of Health Care Delivery,Mayo Clinic,Rochester,MN 55905,United States [12]Department of Hospital Medicine,Mayo Clinic Health System,Mankato,MN 56001,United States [13]Department of Medicine,Mayo Clinic Health System,Mankato,MN 56001,United States [14]Department of Hospital Medicine,Christus Sphon Hospital-shoreline,Corpus Christo,TX 78404,United States [15]Department of Pulmonary,Critical Care&Sleep Medicine,Texas A&M University,College Station,TX 77843,United States [16]Department of Critical Care Medicine,Mayo Clinic Health System,Mankato,MN 56001,United States

出　　处：《World Journal of Cardiology》2023年第6期309-323,共15页世界心脏病学杂志（英文版）（电子版）

摘　　要：BACKGROUND ST-elevation myocardial infarction(STEMI)is the result of transmural ischemia of the myocardium and is associated with a high mortality rate.Primary percutaneous coronary intervention(PPCI)is the recommended first-line treatment strategy for patients with STEMI.The timely delivery of PPCI became extremely challenging for STEMI patients during the coronavirus disease 2019(COVID-19)pandemic,leading to a projected steep rise in mortality.These delays were overcome by the shift from first-line therapy and the development of modern fibrinolytic-based reperfusion.It is unclear whether fibrinolytic-based reperfusion therapy is effective in improving STEMI endpoints.AIM To determine the incidence of fibrinolytic therapy during the COVID-19 pandemic and its effects on STEMI clinical outcomes.METHODS PubMed,Google Scholar,Scopus,Web of Science,and Cochrane Central Register of Controlled Trials were queried from January 2020 up to February 2022 to identify studies investigating the effect of fibrinolytic therapy on the prognostic outcome of STEMI patients during the pandemic.Primary outcomes were the incidence of fibrinolysis and the risk of all-cause mortality.Data were meta-analyzed using the random effects model to derive odds ratios(OR)and 95%confidence intervals.Quality assessment was carried out using the Newcastle-Ottawa scale.RESULTS Fourteen studies including 50136 STEMI patients(n=15142 in the pandemic arm;n=34994 in the pre-pandemic arm)were included.The mean age was 61 years;79%were male,27%had type 2 diabetes,and 47%were smokers.Compared with the pre-pandemic period,there was a significantly increased overall incidence of fibrinolysis during the pandemic period[OR:1.80(1.18 to 2.75);I2=78%;P=0.00;GRADE:Very low].The incidence of fibrinolysis was not associated with the risk of all-cause mortality in any setting.The countries with a low-and middle-income status reported a higher incidence of fibrinolysis[OR:5.16(2.18 to 12.22);I2=81%;P=0.00;GRADE:Very low]and an increased risk of all-cause mortality i

关 键 词：ST-elevation myocardial infarction Myocardial infarction Thrombolytic therapy FIBRINOLYSIS COVID-19 Pandemics 

分 类 号：R542.22[医药卫生—心血管疾病]