Systematic Reviews
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Jun 26, 2023; 15(6): 309-323
Published online Jun 26, 2023. doi: 10.4330/wjc.v15.i6.309
Effect of fibrinolytic therapy on ST-elevation myocardial infarction clinical outcomes during the COVID-19 pandemic: A systematic review and meta-analysis
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
Anwar Khedr, Department of Internal Medicine, BronxCare Health System, Bronx, NY 10457, United States
Hussam Al Hennawi, Department of Internal Medicine, Jefferson Abington Hospital, Abington, PA 19001, United States
Muhammed Khuzzaim Khan, Department of Internal Medicine, Dow University of Health Science, Karachi 74200, Pakistan
Mostafa Elbanna, Department of Internal Medicine, Rochester Regional Health, Rochester, NY 14621, United States
Abbas B Jama, Department of Critical Care, Mayo Clinic Health System, Mankato, MN 56001, United States
Ekaterina Proskuriakova, Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL 60608, United States
Hisham Mushtaq, Department of Internal Medicine, St. Vincent's Medical Center, Bridgeport, CT 06606, United States
Mikael Mir, Sydney Boike, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, United States
Ibtisam Rauf, Department of Medicine, St. George's University, School of Medicine, St George SW17 0RE, Grenada
Aalaa Eissa, Department of Medicine, KFS University, KFS 33511, Egypt
Meritxell Urtecho, Department of Medicine, Robert D and Patricia E. Kern Center of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, United States
Thoyaja Koritala, Department of Hospital Medicine, Mayo Clinic Health System, Mankato, MN 56001, United States
Nitesh Jain, Department of Medicine, Mayo Clinic Health System, Mankato, MN 56001, United States
Lokesh Goyal, Department of Hospital Medicine, Christus Sphon Hospital-shoreline, Corpus Christo, TX 78404, United States
Salim Surani, Department of Pulmonary, Critical Care & Sleep Medicine, Texas A&M University, College Station, TX 77843, United States
Syed A Khan, Department of Critical Care Medicine, Mayo Clinic Health System, Mankato, MN 56001, United States
Author contributions: Khedr A substantial contributions to conception and design of the study, drafting the article, final approval; Hennawi HA acquisition of data, or analysis and interpretation of data, drafting the article, final approval; Khan MK analysis of data, revising and drafting the article, final approval; Elbanna M performed the data analysis, drafting the article, final approval; Jama AB and Proskuriakova E interpretation of data, drafting the article, final approval; Mushtaq H and Jain N contributed to the acquisition of data, revising the article, final approval; Mir M, Boike S, Rauf I, Eissa A, Koritala T, and Khan SA contributed to the interpretation of data, revising the article, final approval; Urtecho M contributed to the interpretation of data, making critical revisions, final approval; Surani S contributed to the acquisition of data, making critical revisions, final approval.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Salim Surani, FCCP, MD, MHSc, Professor, Department of Pulmonary, Critical Care & Sleep Medicine, Texas A&M University, Administration Building, 400 Bizzell St, College Station, TX 77843, United States. srsurani@hotmail.com
Received: December 9, 2022
Peer-review started: December 9, 2022
First decision: March 15, 2023
Revised: March 30, 2023
Accepted: May 19, 2023
Article in press: May 19, 2023
Published online: June 26, 2023
ARTICLE HIGHLIGHTS
Research background

ST-elevation myocardial infarction (STEMI) is a severe form of coronary artery disease with high morbidity and mortality rates. The preferred treatment is primary percutaneous coronary intervention, but the coronavirus disease 2019 (COVID-19) pandemic led to changes in STEMI management, including the use of fibrinolytic therapy as an alternative treatment.

Research motivation

The COVID-19 pandemic placed a significant strain on healthcare resources and providers, leading to changes in STEMI management. However, the impact of fibrinolytic therapy on clinical outcomes during the pandemic remains largely unknown.

Research objectives

The aim of this systematic review is to examine the significance of the increase in fibrinolytic therapy in adult STEMI patients during the COVID-19 pandemic compared to the pre-COVID-19 era and to assess the impact of this treatment strategy on clinical outcomes, particularly the risk of all-cause mortality, in comparison to patients who received standard-care before or during the pandemic.

Research methods

This study analyzed the incidence of fibrinolytic therapy and all-cause mortality for STEMI patients during the COVID-19 pandemic compared to the pre-pandemic period. Data synthesis and analysis were performed using the DerSimonian and Laird random-effects model, subgrouping studies based on changes in fibrinolysis incidence and economic status of countries. The study used sensitivity analysis, meta-regression analysis, and Begg’s funnel plot test to assess publication bias and heterogeneity. Statistical significance was set at < 0.05.

Research results

This meta-analysis of 14 studies revealed a significantly higher incidence of fibrinolytic therapy in adult STEMI patients during the COVID-19 pandemic compared to the pre-pandemic era. Patients in low- and middle-income countries (LMICs) were more likely to receive fibrinolytic therapy, and those who received it in LMICs had a higher risk of all-cause mortality. However, overall, there was no significant association between the all-cause mortality rate and the incidence of fibrinolytic therapy. Meta-regression analysis showed that hyperlipidemia and hypertension were significant predictors of all-cause mortality, indicating that managing these conditions may be crucial in reducing mortality risk.

Research conclusions

The incidence of fibrinolytic therapy for STEMI patients increased during the COVID-19 pandemic, particularly in LMICs. However, there was no significant association between fibrinolysis and all-cause mortality. The findings of this study have important implications for public health initiatives.

Research perspectives

Fibrinolytic therapy was more frequently used during the COVID-19 pandemic, particularly in LMICs, but no significant association was found between the incidence of fibrinolysis and overall all-cause mortality.