For the critical outcome of 30-day mortality, we have identified moderate-quality evidence (downgraded for imprecision) from 7 RCTs(Widimsky 2000, 823-831; Scheller 2003, 634-641; Fernandez-Aviles 2004, 1045-1053; Le May 2005, 417-424; Armstrong 2006, 1530-1538; Cantor 2009, 2705-2718; Bohmer 2010, 102-110) enrolling 2355 patients showing no differential benefit to either therapy (immediate in-hospital fibrinolysis and routine transfer for angiography at 3 to 6 hours [or up to 24 hours], compared with immediate in-hospital fibrinolysis and only transfer for ischemia-driven PCI [rescue PCI] in first 24 hours) (OR, 0.96; 95% CI, 0.64–1.44) (Figure 12).
For the critical outcome of 1-year mortality, we have identified moderate-quality evidence (downgraded for imprecision) from 6 RCTs(Bednar 2003, 1133-1137; Scheller 2003, 634-641; Fernandez-Aviles 2004, 1045-1053; Armstrong 2006, 1530-1538; Bohmer 2010, 102-110; Bagai 2013, 630-637) enrolling 2275 STEMI patients showing no benefit to either therapy (immediate in-hospital fibrinolysis and routine transfer for angiography at 3 to 6 hours [or up to 24 hours], compared with immediate in-hospital fibrinolysis and only transfer for ischemia-driven PCI [rescue PCI] in first 24 hours) (OR, 0.54; 95% CI, 0.16–1.89).
For the critical outcome of intracranial hemorrhage, we have identified moderate-quality evidence (downgraded for imprecision) from 6 RCTs(Scheller 2003, 634-641; Fernandez-Aviles 2004, 1045-1053; Le May 2005, 417-424; Armstrong 2006, 1530-1538; Cantor 2009, 2705-2718; Bohmer 2010, 102-110) enrolling 2156 STEMI patients, showing no differential harm from either therapy (immediate in-hospital fibrinolysis and routine transfer for angiography at 3 to 6 hours [or up to 24 hours], compared with immediate in-hospital fibrinolysis and only transfer for ischemia-driven PCI [rescue PCI] in first 24 hours) (OR, 0.71; 95% CI, 0.34–1.44).
For the important outcome of major bleeding, we have identified moderate-quality evidence (downgraded for imprecision) from 6 RCTs(Scheller 2003, 634-641; Fernandez-Aviles 2004, 1045-1053; Le May 2005, 417-424; Armstrong 2006, 1530-1538; Cantor 2009, 2705-2718; Bohmer 2010, 102-110) enrolling 2156 STEMI patients showing no differential harm from either therapy (immediate in-hospital fibrinolysis and routine transfer for angiography at 3 to 6 hours [or up to 24 hours], compared with immediate in-hospital fibrinolysis and only transfer for ischemia-driven PCI [rescue PCI] in first 24 hours) (OR, 0.88; 95% CI, 0.61–1.27).
For the important outcome of stroke we have identified moderate-quality evidence (downgraded for imprecision) from 4 RCTs(Widimsky 2000, 823-831; Scheller 2003, 634-641; Le May 2005, 417-424; Bohmer 2010, 102-110) enrolling 798 STEMI patients showing no differential harm from either therapy (immediate in-hospital fibrinolysis and routine transfer for angiography at 3 to 6 hours [or up to 24 hours], compared with immediate in-hospital fibrinolysis and only transfer for ischemia-driven PCI [rescue PCI] in first 24 hours) (OR, 0.99; 95% CI, 0.39–2.51).
For the important outcome of reinfarction, we have identified moderate-quality evidence (downgraded for risk of bias) from 7 RCTs(Widimsky 2000, 823-831; Scheller 2003, 634-641; Fernandez-Aviles 2004, 1045-1053; Le May 2005, 417-424; Armstrong 2006, 1530-1538; Cantor 2009, 2705-2718; Bohmer 2010, 102-110) in 2355 patients of benefit of immediate in-hospital fibrinolysis and routine transfer for angiography at 3 to 6 hours (or up to 24 hours), compared with immediate in-hospital fibrinolysis and only transfer for ischemia-driven PCI (rescue PCI) in first 24 hours (OR, 0.57; 95% CI, 0.38–0.85).
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