{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T10:08:08Z","timestamp":1791886088692,"version":"4.3.4"},"reference-count":38,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T00:00:00Z","timestamp":1759968000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>To compare the pharmacoinvasive strategy (PS) versus fibrinolysis alone in adults with ST-segment elevation myocardial infarction.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We searched PubMed\/MEDLINE, Web of Science, Embase, and Cochrane Library from inception until January 17th, 2025. The review protocol was registered in PROSPERO (CRD42022309130). We included randomized controlled trials (RCTs), assessed risk of bias with the Cochrane Risk of Bias 1.0 tool, and calculated pooled relative risks and mean differences. We used GRADE\u2019s minimally contextualized approach to determine the certainty of the evidence.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>We found 7 RCTs (n\u2009=\u20093053). The PS, compared to fibrinolysis alone, may have an important reduction on mortality (3.3% vs 3.9%; \u22125 per 1000; 95% CI: \u221216 to +10); and has an important reduction on reinfarction (2.6% vs 4.4%; \u221219 per 1000; 95% CI: \u221227 to \u22126), revascularization (9.0% vs 26.8%; \u2212169 per 1000; 95% CI: \u2212220 to \u221264), and recurrent ischemia (1.2% vs 5.7%; \u221246 per 1000; 95% CI: \u221252 to \u221227) at 30 days follow up. Similar results were found at longest follow up for the outcomes mentioned. PS probably has an important reduction on mean hospital stay length at longest follow up (\u22122.47 days; 95% CI: \u22124.17 to \u22120.78) and may reduce cardiac failure and cardiogenic shock at 30 days, but the evidence is very uncertain. PS has trivial or no effect on major bleeding (4.6% vs 5.0%; \u22124 per 1000; 95% CI: \u221217 to +13) and may have an important reduction on stroke (0.7% vs 1.3%; \u22126 per 1000: 95 CI: \u221210 to +2).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The PS has an important reduction on reinfarction, revascularization, and recurrent ischemia; probably has an important reduction on mean hospital stay length; and may have an important reduction of mortality and stroke. Also, PS may reduce cardiac failure and cardiogenic shock, but the evidence is very uncertain. The risk of major bleeding did not increase.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0334309","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:45:07Z","timestamp":1760031907000},"page":"e0334309","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Pharmacoinvasive strategy versus fibrinolytic therapy alone in adults with ST-elevation myocardial infarction: A systematic review and meta-analysis"],"prefix":"10.1371","volume":"20","author":[{"given":"David R.","family":"Soriano-Moreno","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly G.","family":"Tuco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina J.","family":"Delgado Flores","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Flores-Lovon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3172-2113","authenticated-orcid":true,"given":"Fabricio","family":"Ccami-Bernal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renatta","family":"Quijano-Escate","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis Marcos","family":"L\u00f3pez-Rojas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0487-5547","authenticated-orcid":true,"given":"Sergio","family":"Goicochea-Lugo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,10,9]]},"reference":[{"issue":"5","key":"pone.0334309.ref001","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1161\/01.CIR.0000134791.68010.FA","article-title":"ACC\/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary: a report of the American College of Cardiology\/American heart association task force on practice guidelines (Writing committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction)","volume":"110","author":"EM Antman","year":"2004","journal-title":"Circulation"},{"issue":"44","key":"pone.0334309.ref002","doi-asserted-by":"crossref","first-page":"4536","DOI":"10.1093\/eurheartj\/ehab342","article-title":"Reperfusion therapies and in-hospital outcomes for ST-elevation myocardial infarction in Europe: the ACVC-EAPCI EORP STEMI registry of the European Society of Cardiology","volume":"42","author":"U Zeymer","year":"2021","journal-title":"Eur Heart J"},{"key":"pone.0334309.ref003","doi-asserted-by":"crossref","first-page":"101438","DOI":"10.1016\/j.jacadv.2024.101438","article-title":"Improving STEMI management internationally","volume":"4","author":"CJ Herrera","year":"2025","journal-title":"JACC Adv"},{"issue":"1","key":"pone.0334309.ref004","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1038\/s41572-019-0090-3","article-title":"ST-segment elevation myocardial infarction","volume":"5","author":"B Vogel","year":"2019","journal-title":"Nat Rev Dis Primers"},{"issue":"24","key":"pone.0334309.ref005","doi-asserted-by":"crossref","first-page":"2004","DOI":"10.1161\/CIRCULATIONAHA.119.041297","article-title":"Resource and infrastructure-appropriate management of ST-segment elevation myocardial infarction in low- and middle-income countries","volume":"141","author":"Y Chandrashekhar","year":"2020","journal-title":"Circulation"},{"issue":"2","key":"pone.0334309.ref006","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1093\/eurheartj\/ehx393","article-title":"2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)","volume":"39","author":"B Ibanez","year":"2018","journal-title":"Eur Heart J"},{"issue":"10096","key":"pone.0334309.ref007","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1016\/S0140-6736(17)31441-1","article-title":"Comparative efficacy and safety of reperfusion therapy with fibrinolytic agents in patients with ST-segment elevation myocardial infarction: a systematic review and network meta-analysis","volume":"390","author":"P Jinatongthai","year":"2017","journal-title":"Lancet"},{"issue":"12","key":"pone.0334309.ref008","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.119.015186","article-title":"Comparison of reperfusion strategies for ST-segment-elevation myocardial infarction: a multivariate network meta-analysis","volume":"9","author":"R Fazel","year":"2020","journal-title":"J Am Heart Assoc"},{"issue":"21","key":"pone.0334309.ref009","doi-asserted-by":"crossref","first-page":"2480","DOI":"10.1161\/01.CIR.0000128736.57259.48","article-title":"Pharmacoinvasive therapy: the future of treatment for ST-elevation myocardial infarction","volume":"109","author":"EM Antman","year":"2004","journal-title":"Circulation"},{"issue":"2","key":"pone.0334309.ref010","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1055\/s-0033-1356649","article-title":"A randomized comparison between everolimus-eluting stent and cobalt chromium stent in patients with acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention using routine intravenous eptifibatide: the X-MAN (Xience vs. multi-link stent in acute myocardial infarction) trial, a pilot study","volume":"23","author":"S Dharma","year":"2014","journal-title":"Int J Angiol"},{"issue":"11","key":"pone.0334309.ref011","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1007\/s11892-020-01354-4","article-title":"Social determinants of poor management of type 2 diabetes among the insured","volume":"20","author":"MR Patel","year":"2020","journal-title":"Curr Diab Rep"},{"issue":"5","key":"pone.0334309.ref012","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.115.001767","article-title":"Standardized outcome measurement for patients with coronary artery disease: consensus from the international consortium for health outcomes measurement (ICHOM)","volume":"4","author":"RL McNamara","year":"2015","journal-title":"J Am Heart Assoc"},{"key":"pone.0334309.ref013","article-title":"The cochrane collaboration\u2019s tool for assessing risk of bias in randomised trials","volume":"343","author":"JPT Higgins","year":"2011","journal-title":"BMJ"},{"issue":"10454","key":"pone.0334309.ref014","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1016\/S0140-6736(24)01357-6","article-title":"Antivirals for post-exposure prophylaxis of influenza: a systematic review and network meta-analysis","volume":"404","author":"Y Zhao","year":"2024","journal-title":"Lancet"},{"issue":"3","key":"pone.0334309.ref015","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/0197-2456(86)90046-2","article-title":"Meta-analysis in clinical trials","volume":"7","author":"R DerSimonian","year":"1986","journal-title":"Control Clin Trials"},{"key":"pone.0334309.ref016","article-title":"Analysing data and undertaking meta-analyses.","volume-title":"Cochrane handbook for systematic reviews of interventions","author":"J Deeks","year":"2022"},{"issue":"4","key":"pone.0334309.ref017","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/j.jclinepi.2010.04.026","article-title":"GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables","volume":"64","author":"G Guyatt","year":"2011","journal-title":"J Clin Epidemiol"},{"key":"pone.0334309.ref018","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.jclinepi.2021.03.026","article-title":"GRADE guidelines 32: GRADE offers guidance on choosing targets of GRADE certainty of evidence ratings","volume":"137","author":"L Zeng","year":"2021","journal-title":"J Clin Epidemiol"},{"key":"pone.0334309.ref019","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1016\/j.jclinepi.2022.07.014","article-title":"GRADE guidance 34: update on rating imprecision using a minimally contextualized approach","volume":"150","author":"L Zeng","year":"2022","journal-title":"J Clin Epidemiol"},{"issue":"15","key":"pone.0334309.ref020","doi-asserted-by":"crossref","first-page":"1379","DOI":"10.1056\/NEJMoa1301092","article-title":"Fibrinolysis or primary PCI in ST-segment elevation myocardial infarction","volume":"368","author":"PW Armstrong","year":"2013","journal-title":"N Engl J Med"},{"key":"pone.0334309.ref021","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/j.jclinepi.2019.10.014","article-title":"GRADE guidelines 26: informative statements to communicate the findings of systematic reviews of interventions","volume":"119","author":"N Santesso","year":"2020","journal-title":"J Clin Epidemiol"},{"issue":"26","key":"pone.0334309.ref022","doi-asserted-by":"crossref","first-page":"2705","DOI":"10.1056\/NEJMoa0808276","article-title":"Routine early angioplasty after fibrinolysis for acute myocardial infarction","volume":"360","author":"WJ Cantor","year":"2009","journal-title":"N Engl J Med"},{"issue":"2","key":"pone.0334309.ref023","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.jacc.2009.08.007","article-title":"Efficacy and safety of immediate angioplasty versus ischemia-guided management after thrombolysis in acute myocardial infarction in areas with very long transfer distances results of the NORDISTEMI (NORwegian study on DIstrict treatment of ST-elevation myocardial infarction)","volume":"55","author":"E B\u00f8hmer","year":"2010","journal-title":"J Am Coll Cardiol"},{"issue":"9612","key":"pone.0334309.ref024","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1016\/S0140-6736(08)60268-8","article-title":"Immediate angioplasty versus standard therapy with rescue angioplasty after thrombolysis in the Combined Abciximab REteplase Stent Study in Acute Myocardial Infarction (CARESS-in-AMI): an open, prospective, randomised, multicentre trial","volume":"371","author":"C Di Mario","year":"2008","journal-title":"Lancet"},{"issue":"13","key":"pone.0334309.ref025","doi-asserted-by":"crossref","first-page":"1530","DOI":"10.1093\/eurheartj\/ehl088","article-title":"A comparison of pharmacologic therapy with\/without timely coronary intervention vs. primary percutaneous intervention early after ST-elevation myocardial infarction: the WEST (Which Early ST-elevation myocardial infarction Therapy) study","volume":"27","author":"WEST Steering Committee","year":"2006","journal-title":"Eur Heart J"},{"issue":"19","key":"pone.0334309.ref026","doi-asserted-by":"crossref","first-page":"1956","DOI":"10.1093\/eurheartj\/ehi432","article-title":"Comparison of pre-hospital combination-fibrinolysis plus conventional care with pre-hospital combination-fibrinolysis plus facilitated percutaneous coronary intervention in acute myocardial infarction","volume":"26","author":"H Thiele","year":"2005","journal-title":"Eur Heart J"},{"issue":"9439","key":"pone.0334309.ref027","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1016\/S0140-6736(04)17059-1","article-title":"Routine invasive strategy within 24 hours of thrombolysis versus ischaemia-guided conservative approach for acute myocardial infarction with ST-segment elevation (GRACIA-1): a randomised controlled trial","volume":"364","author":"F Fernandez-Avil\u00e9s","year":"2004","journal-title":"Lancet"},{"issue":"4","key":"pone.0334309.ref028","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1016\/S0735-1097(03)00763-0","article-title":"Beneficial effects of immediate stenting after thrombolysis in acute myocardial infarction","volume":"42","author":"B Scheller","year":"2003","journal-title":"J Am Coll Cardiol"},{"issue":"4","key":"pone.0334309.ref029","doi-asserted-by":"crossref","DOI":"10.1016\/j.ahj.2012.12.016","article-title":"Clinical outcomes and cost implications of routine early PCI after fibrinolysis: one-year follow-up of the Trial of Routine Angioplasty and Stenting after Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction (TRANSFER-AMI) study","volume":"165","author":"A Bagai","year":"2013","journal-title":"Am Heart J"},{"issue":"6","key":"pone.0334309.ref030","first-page":"736","article-title":"Long-term follow-up of the trial of routine angioplasty and stenting after fibrinolysis to enhance reperfusion in acute myocardial infarction (TRANSFER-AMI)","volume":"34","author":"Y Arbel","year":"2018","journal-title":"Can J Cardiol"},{"issue":"3","key":"pone.0334309.ref031","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.ahj.2012.05.022","article-title":"Efficacy of early invasive management post-fibrinolysis in men versus women with ST-elevation myocardial infarction: a subgroup analysis from trial of routine angioplasty and stenting after fibrinolysis to enhance reperfusion in acute myocardial infarction (TRANSFER-AMI)","volume":"164","author":"V Bhan","year":"2012","journal-title":"Am Heart J"},{"key":"pone.0334309.ref032","first-page":"17","article-title":"Prevalence and associated factors of mortality after percutaneous coronary intervention for adult patients with ST-elevation myocardial infarction: a systematic review and meta-analysis","volume":"28","author":"F Yan","year":"2023","journal-title":"J Res Med Sci"},{"issue":"6","key":"pone.0334309.ref033","first-page":"970","article-title":"Hospital mortality from myocardial infarction in latin America and the Caribbean: systematic review and meta-analysis","volume":"119","author":"L Alves","year":"2022","journal-title":"Arq Bras Cardiol"},{"key":"pone.0334309.ref034","doi-asserted-by":"crossref","DOI":"10.1161\/circ.150.suppl_1.4137274","article-title":"Abstract 4137274: optimal timing of pharmacoinvasive strategy and its impact on clinical in patients with ST-elevation myocardial infarction: a real-world perspective","volume":"150","author":"A Stephanus","year":"2024","journal-title":"Circulation"},{"issue":"1","key":"pone.0334309.ref035","first-page":"91","article-title":"Thrombolysis in the age of primary percutaneous coronary intervention: mini-review and meta-analysis of early PCI","volume":"7","author":"O Al Shammeri","year":"2013","journal-title":"Int J Health Sci (Qassim)"},{"issue":"7","key":"pone.0334309.ref036","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1016\/j.jclinepi.2014.12.015","article-title":"Quality of evidence is a key determinant for making a strong GRADE guidelines recommendation","volume":"68","author":"B Djulbegovic","year":"2015","journal-title":"J Clin Epidemiol"},{"key":"pone.0334309.ref037","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.jclinepi.2017.05.006","article-title":"The GRADE working group clarifies the construct of certainty of evidence","volume":"87","author":"M Hultcrantz","year":"2017","journal-title":"J Clin Epidemiol"},{"issue":"4","key":"pone.0334309.ref038","doi-asserted-by":"crossref","DOI":"10.1161\/CIR.0b013e3182742c84","article-title":"2013 ACCF\/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American college of cardiology foundation\/American heart association task force on practice guidelines","volume":"127","author":"PT O\u2019Gara","year":"2013","journal-title":"Circulation"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0334309","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:45:14Z","timestamp":1760031914000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0334309"}},"subtitle":[],"editor":[{"given":"Parisa","family":"Fallahtafti","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,10,9]]},"references-count":38,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10,9]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0334309","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,9]]}}}