Abstract 12899: Early Intervention in Transient ST-Elevation Myocardial Infarction Decreases Mortality: A Meta-Analysis
Introduction: About one-fourth of patient with acute coronary syndrome present with transient ST-elevation myocardial infarction (STEMI). No specific recommendations exist in current guidelines regarding the timing of intervention for such patients due to lack of high-quality randomized trials. Methods: The Cochrane library and PubMed databases were searched for relevant studies. Two authors independently screened and included studies that were randomized controlled trials or observational studies comparing early with delayed invasive strategies in transient STEMI. Efficacy outcomes included target vessel revascularization, reinfarction and recurrent ischemia rates. Primary safety outcome was major bleeding. Random-effects model was used for pooled calculation of odds ratio (OR). Results: Out of all studies found, only 4 studies were included in our analysis (295 patients in early intervention group and 307 patients in delayed intervention group). Delayed intervention was associated with significant increase in all-cause mortality (OR: 2.81 [1.39-5.68], I 2 = 0%, p value = 0.004) (Figure 1). We did not find any significant difference in reinfarction rate (OR: 0.75 [0.12-4.66], I 2 = 0%, p value = 0.75), target vessel revascularization rate (OR: 0.66 [0.11-4.14] I 2 = 0%, p value = 0.66) and recurrent ischemia rate (OR 1.52[0.40-5.84], I 2 = 18 %, p value = 0.54). In addition, major bleeding rate was also similar in both groups (OR 0.68 [0.25-2.25], I 2 = 12%, p value = 0.60). Conclusions: This low to moderate-quality evidence suggests that early invasive strategy might reduce the mortality rate in transient STEMI. There is need of well-designed large randomized studies to gather further evidence regarding the best management of transient STEMI.