| Comparison of primary coronary angioplasty and intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review. | |
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MedLine Citation:
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PMID: 9403425 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To provide a quantitative review of the treatment effects of primary coronary angioplasty vs intravenous thrombolysis for acute myocardial infarction. DATA SOURCES: Ten randomized trials were identified through computerized bibliographic search of MEDLINE from January 1985 through March 1996 and by queries of principal investigators. STUDY SELECTION: Single-center and multicenter randomized trials comparing primary angioplasty with intravenous thrombolytic therapy among 2606 patients were included. Four trials compared angioplasty with streptokinase, 3 compared angioplasty with a 3- to 4-hour infusion of tissue-type plasminogen activator, and 3 compared angioplasty with "accelerated" administration of tissue-type plasminogen activator over 90 minutes. DATA EXTRACTION: Each investigator provided definitions and exact data for outcome events. Odds ratios (ORs), 95% confidence intervals (CIs), and P values were calculated using exact tests for categorical data. DATA SYNTHESIS: Mortality at 30 days or less was 4.4% for the 1290 patients treated with primary angioplasty compared with 6.5% for the 1316 patients treated with thrombolysis (34% reduction; OR, 0.66; 95% CI, 0.46-0.94; P=.02). The effect was similar among thrombolytic regimens, and no subgroup demonstrated a significant reduction in death. The rates of death or nonfatal reinfarction were 7.2% for angioplasty and 11.9% for thrombolytic therapy (OR, 0.58; 95% CI, 0.44-0.76; P<.001). Angioplasty was associated with a significant reduction in total stroke (0.7% vs 2.0%; P=.007) and hemorrhagic stroke (0.1% vs 1.1%; P<.001). CONCLUSIONS: Based on outcomes at hospital discharge or 30 days, primary angioplasty appears to be superior to thrombolytic therapy for treatment of patients with acute myocardial infarction, with the proviso that success rates for angioplasty are as good as those achieved in these trials. Data evaluating longer-term outcomes, operator experience, and time delay before treatment are needed before primary angioplasty can be universally recommended as the preferred treatment. |
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Authors:
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W D Weaver; R J Simes; A Betriu; C L Grines; F Zijlstra; E Garcia; L Grinfeld; R J Gibbons; E E Ribeiro; M A DeWood; F Ribichini |
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Publication Detail:
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Type: Comparative Study; Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: JAMA : the journal of the American Medical Association Volume: 278 ISSN: 0098-7484 ISO Abbreviation: JAMA Publication Date: 1997 Dec |
Date Detail:
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Created Date: 1997-12-31 Completed Date: 1997-12-31 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 7501160 Medline TA: JAMA Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 2093-8 Citation Subset: AIM; IM |
Affiliation:
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Heart and Vascular Institute, Henry Ford Health System, Detroit, MI 48202, USA. wweaver1@hfhs.org |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Angioplasty, Transluminal, Percutaneous Coronary* Cerebrovascular Disorders Health Services Research* Humans Infusions, Intravenous Logistic Models Myocardial Infarction / mortality, therapy* Outcome and Process Assessment (Health Care) / methods* Plasminogen Activators / administration & dosage*, therapeutic use Randomized Controlled Trials as Topic Recurrence Risk Streptokinase / administration & dosage, therapeutic use Survival Analysis Thrombolytic Therapy* Tissue Plasminogen Activator / administration & dosage, therapeutic use United States / epidemiology |
| Chemical | |
Reg. No./Substance:
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EC 3.4.-/Streptokinase; EC 3.4.21.-/Plasminogen Activators; EC 3.4.21.68/Tissue Plasminogen Activator |
| Comments/Corrections | |
Comment In:
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ACP J Club. 1998 May-Jun;128(3):59 JAMA. 1997 Dec 17;278(23):2110-1 [PMID: 9403429 ] |
Erratum In:
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JAMA 1998 Jun 17;279(23):1876 |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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