| Comparison of primary percutaneous coronary intervention and fibrinolytic therapy in ST-segment-elevation myocardial infarction: bayesian hierarchical meta-analyses of randomized controlled trials and observational studies. | |
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MedLine Citation:
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PMID: 19506117 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Published meta-analyses comparing primary percutaneous coronary intervention with fibrinolytic therapy in patients with ST-segment-elevation myocardial infarction include only randomized controlled trials (RCTs). We aim to obviate the limited applicability of RCTs to real-world settings by undertaking meta-analyses of both RCTs and observational studies. METHODS AND RESULTS: We included all RCTs and observational studies, without language restriction, published up to May 1, 2008. We completed separate bayesian hierarchical random-effect meta-analyses for 23 RCTs (8140 patients) and 32 observational studies (185 900 patients). Primary percutaneous coronary intervention was associated with reductions in short-term (< or =6-week) mortality of 34% (odds ratio, 0.66; 95% credible interval, 0.51 to 0.82) in randomized trials, and 23% lower mortality (odds ratio, 0.77; 95% credible interval, 0.62 to 0.95) in observational studies. Primary percutaneous coronary intervention was associated with reductions in stroke of 63% in RCTs and 61% in observational studies. At long-term follow-up (> or =1 year), primary percutaneous coronary intervention was associated with a 24% reduction in mortality (odds ratio, 0.76; 95% credible interval, 0.58 to 0.95) and a 51% reduction in reinfarction (odds ratio, 0.49; 95% credible interval, 0.32 to 0.66) in RCTs. However, there was no conclusive benefit of primary percutaneous coronary intervention in the long term in the observational studies. CONCLUSIONS: Compared with fibrinolytic therapy, primary percutaneous coronary intervention was associated with short-term reductions in mortality, reinfarction, and stroke in ST-segment-elevation myocardial infarction. Primary percutaneous coronary intervention was associated with long-term reductions in mortality and reinfarction in RCTs, but there was no conclusive evidence for a long-term benefit in mortality and reinfarction in observational studies. |
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Authors:
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Thao Huynh; Stephane Perron; Jennifer O'Loughlin; Lawrence Joseph; Michel Labrecque; Jack V Tu; Pierre Théroux |
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Publication Detail:
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Type: Comparative Study; Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't Date: 2009-06-08 |
Journal Detail:
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Title: Circulation Volume: 119 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2009 Jun |
Date Detail:
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Created Date: 2009-06-23 Completed Date: 2009-07-14 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: 3101-9 Citation Subset: AIM; IM |
Affiliation:
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1650 Ave Cedar, Room E-5200, Montreal, Quebec, H3G-1A4, Canada. thao.huynhthanh@mail.mcgill.ca |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Female Fibrinolysis* Heart Catheterization* Humans Male Myocardial Infarction / mortality*, therapy* Predictive Value of Tests Randomized Controlled Trials as Topic Stroke / etiology Thrombolytic Therapy* Time Factors |
| Comments/Corrections | |
Comment In:
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Circulation. 2009 Jun 23;119(24):3047-9
[PMID:
19506103
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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