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Table 1 Study characteristics of randomized clinical trials comparing an invasive treatment strategy to a delayed invasive or ischemia-guided approach among STEMI patients treated with fibrinolysis.

From: Routine invasive management after fibrinolysis in patients with ST-elevation myocardial infarction: a systematic review of randomized clinical trials

Study

Year

Sample Size

Comparator

Angiogram in Invasive Group (%)

Angiogram in Selective Group (%)

PCI in Invasive Group (%)

PCI in Selective Group (%)

Clopidogrel Use in Invasive Group (%)

Clopidogrel Use in Selective Group (%)

Follow-Up (Month)

PRAGUE[16, 17]

2000

300*

Streptokinase

NR

NR

82†

7†

All received ticlopidine

1

SIAM-3[18]

2003

197‡

Reteplase with elective stenting 2 weeks post-thrombolysis

100

100

100

100

100

100#

9.4 ± 7.4

GRACIA-1[19]

2004

500

Recombinant tissue plasminogen activator with ischemia-guided approach

100

21

81.4Â¥

20.3

NR

NR

12

CAPITAL-AMI[20]

2005

170

TNK-alone with rescue PCI PRN

100

67

100

50

91

57

6

Leipzig[23]

2005

164

Combination half-dose reteplase and abciximab with rescue PCI PRN and elective PCI recommended before hospital discharge

100

NR

96

91

88

77##

6

WEST[25]

2006

304€

TNK followed by 'usual standard of care'

98.1

NR

78.8£

60

NR

NR

1

CARESS-AMI[26]

2008

600

Combination half-dose reteplase and abciximab with transfer for rescue PCI PRN††

97.0

35.7

85.6

30.3

85.9**

57.1**

1

TRANSFER AMI[27]

2009

1,059

TNK with rescue PCI PRN and recommended angiogram within 2 weeks of Index MI

98.5

89

85

67

89††

69††

6

NORDISTEMI[28]

2009

266‡‡

TNK with ischemia-guided approach

99¥¥

95¥¥

89

71

100

12

  1. Abbreviations: MI: myocardial infarction; PCI: percutaneous coronary intervention; PRN: as needed; STEMI: ST-elevation myocardial infarction; TNK: tenecteplase. *Of the 300 patients randomized in PRAGUE, 101 were randomized to primary PCI and are not included in this analysis. A total of 100 patients were randomized to streptokinase + PCI and 99 were randomized to streptokinase alone. †These data represent procedures that occurred within the index hospitalization; 5 patients in the invasive group and 11 patients (including 7 rescue PCI) in the conservative group underwent PCI in the 30 days following randomization. ‡In the SIAM-3 trial, 197 patients were initially randomized. However, only 163 met their secondary inclusion criteria. The remaining 34 patients were excluded. Data presented here are based on the 163 patients who met the secondary inclusion criteria. #Although all patients in the SIAM study received clopidogrel, patients randomized to the delayed invasive approach received clopidogrel 2 weeks later than those randomized to an early invasive approach. ¥Includes 199 patients who underwent stenting of culprit lesion and 3 who underwent stenting of non-culprit lesions. €In the WEST study, 304 patients were randomized to 3 treatment arms. However, only 2 of these arms are considered here (n = 204). ##Most patients in the selective group received clopidogrel at the time of PCI several days after the index event. £Includes 1 patient revascularized after index hospitalization but within 30 days of the index event. **Denotes clopidogrel use at discharge. ††Denotes clopidogrel use before admission or within the first 6 hours. ‡‡A total of 266 patients were randomized. However, 4/138 randomized to immediate transfer for PCI and 6/138 randomized to the ischemia-guided approach were excluded following randomization. Consequently, all analyses are based on 134 and 132 patients, respectively. ¥¥ In the early invasive group, 83% underwent angiography within 3 hours of TNK and 99% with 12 hours. In the selective group, 12% underwent angiography with 3 hours, 33% within 12 hours, and 86% within 30 days.
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BMC Cardiovascular Disorders

ISSN: 1471-2261

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