Objectives. Assess the impact of associating thrombolytics, anticoagulants, antiplatelets, and primary angioplasty (PA) on death, reinfarction (AMI), and major bleeding (MB) in STEMI therapy. Methods. Medline search was performed to identify randomized trials comparing these classes in STEMI treatment, at least 500 patients, providing death, AMI, and MB rates. Similar arms were grouped. Correlation between number of drugs and PA and the outcomes was evaluated, as well as correlation between the year of the study and the outcomes. Results. Fifty-nine papers remained after exclusions. 404.556 patients were divided into 35 groups of arms. There was correlation between the number of drugs and rates of death ( , ) and MB ( , ), confirmed by multivariate regression. This model also showed that PA is associated with lower mortality and increased MB. Year and period of publication correlated with the outcomes: death ( , ), MB ( , ), and AMI ( , ). Conclusion. The increasing complexity of STEMI treatment has resulted in significant reduction in mortality along with increased rates of MB. Overall, however, the benefits of treatment outweigh the associated risks of MB. 1. Introduction Approximately 1.7 million people are hospitalized annually in the United States of America due to acute coronary syndromes (ACS), with almost one-quarter of cases showing ST-elevation acute myocardial infarction (STEMI) [1]. Its physiopathology is closely related to thrombus formation (after a complex process that culminates in platelet adhesion, activation and formation of platelet cluster) and activation of the coagulation cascade, over unstable atherosclerotic plaques [2, 3]. With the evolution of STEMI treatment, drugs acting on these mechanisms: antiplatelet, anticoagulant, and thrombolytic therapies have been extensively tested in numerous studies, in different doses and associations, often in conjunction with interventional techniques, with significant reduction of morbi-mortality. However, there was also a marked increase in major bleeding rates, that is, difficult to measure objectively due to the lack of a standardized methodology for this purpose [4]. Besides this, drug associations not adequately tested in large trials have been incorporated by international guidelines [5–7]. Given the broad spectrum of clinical outcomes (with different definitions) and the heterogeneous criteria for adverse events (specially bleeding) reported in the numerous published studies, it’s very difficult to estimate the real clinical benefit of each drug class for STEMI treatment. Pooled
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