Pharmaco-Invasive Strategy Vs Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction in Latin America: A Meta-Analysis

Background: Primary percutaneous coronary intervention (PCI) is the established treatment for ST-segment elevation myocardial infarction (STEMI), but often it is not readily available in low-resource settings. We assessed the safety and efficacy of the pharmaco-invasive strategy compared to primary PCI for STEMI in Latin America. Methods: MEDLINE, Embase, and Latin American and Caribbean Health Sciences Literature (LILACS) were searched for the period from their inception to September 2023, for studies that compared a pharmaco-invasive strategy vs primary PCI in Latin America. Primary outcomes were major adverse cardiovascular events and bleeding. Secondary outcomes were all-cause mortality, cardiovascular mortality, recurrent myocardial infarction, and stroke. Risk of bias was assessed using the Risk Of Bias In Non-randomized Studies—of Interventions (ROBINS-I) tool. Risk ratios (RRs) and 95% confidence intervals (CIs) from random-effects meta-analyses were reported. Results: Six cohort studies (n = 6621) were included; no clinical trials were found. The follow-up duration ranged from the in-hospital period to 1 year. Patients who underwent a pharmaco-invasive strategy (n = 841) vs a primary PCI (n = 5780) had similar rates of major adverse cardiovascular events (RR 0.82; 95% CI 0.59-1.16), major bleeding (RR 1.18; 95% CI 0.69-2.02), all-cause mortality (RR 0.70; 95% CI 0.47-1.05), cardiovascular mortality (RR 0.80; 95% CI 0.44-1.44), recurrent myocardial infarction (RR 0.54; 95% CI 0.18-1.61), and stroke (RR 1.27; 95% CI 0.17-9.73). Most studies had a serious (33%) or critical (50%) risk of bias. Conclusions: Among patients with STEMI in Latin America, only low-quality observational evidence indicated that cardiovascular outcomes and major bleeding rates were similar for those treated with a pharmaco-invasive strategy vs primary PCI. Randomized studies are needed in Latin America with the development of STEMI networks for better care.