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Inpharma 1119 - 10 Jan 1998
Primary PTCA superior to Table. Meta-analysis results of trials involvingthrombolysis in acute MI? patients with suspected MI according to treatment
Patients ThrombolyticPrimary percutaneous transluminal coronary undergoing therapy recipientsangioplasty (PTCA) appears to be superior to primary PTCAthrombolysis in terms of short-term outcomes in
Overall mortalitypatients with acute myocardial infarction (MI), report a rate (percentage ofmultinational group of researchers.1 However, they patients):emphasise that their retrospective meta-analysis has 4.4 6.5‘several important limitations’. Combined rates of
mortality andThe researchers conducted a meta-analysis of 10nonfatalrandomised trials (including the GUSTO-IIb study*)reinfarctioninvolving 2606 patients with suspected acute MI who (percentage of
were randomised within 12 hours of symptom onset to patients):receive IV thrombolysis or primary PTCA. Of the 1316 7.2 11.9patients who were randomised to receive thrombolytic Rate of nonfataltherapy, 307 received streptokinase, 300 received a 3–4 reinfarction
(percentage ofhour infusion of alteplase [t-PA], and 709 received anpatients):accelerated alteplase regimen.
5.4 2.8Reduced risk of death Rate of total stroke
(percentage ofMeta-analysis revealed that at the end of the studypatients):period in all trials (≤ 30 days), there was a significant
0.7 2reduction in the risk of death among patients whoRate ofreceived primary PTCA compared with thrombolysishaemorrhagic(odds ratio = 0.66). The researchers note that this lower stroke (percentage
mortality rate [see table] represents an additional 21 of patients):lives saved for every 1000 patients treated. 0.1 1.1
Similarly, the pooled rate of death or nonfatalreinfarction was lower in patients who underwent
* See Inpharma 1091: 12, 14 Jun 1997; 800538081primary PTCA compared with thrombolysis. Thisrepresents 46 fewer events per 1000 patients treated 1. Weaver WD, et al. Comparison of primary coronary angioplasty and intravenous
thrombolytic therapy for acute myocardial infarction: a quantitative review.among those who underwent PTCA compared withJAMA: the Journal of the American Medical Association 278: 2093-2098, 17thrombolysis. Dec 1997.
However, the rate of nonfatal reinfarction alone was 2. Yusuf S, et al. Primary angioplasty compared with thrombolytic therapy foracute myocardial infarction. JAMA: the Journal of the American Medicallower among thrombolytic therapy recipients comparedAssociation 278: 2110-2111, 17 Dec 1997.with patients who underwent PTCA. The rates of total 800458992
stroke and haemorrhagic stroke were significantly loweramong patients who underwent PTCA compared withthose who received thrombolytic therapy.
Results ‘not conclusive’Dr Salim Yusuf and Janice Pogue from the Hamilton
Health Sciences Corporation Research Centre,Hamilton, Ontario, Canada, comment that in the above-mentioned trial, the lower mortality and reinfarctionrates achieved with PTCA ‘are promising but notconclusive and the real benefits may well be smaller’.2
They add that ‘ideally, we need well-designed and largertrials conducted in a broad range of hospitals in thecommunity’.
Dr Yusuf and Ms Pogue conclude that ‘direct PTCA isat least a reasonable alternative to thrombolytic therapyin high-risk patients, and in expert hands, may bepreferred in patients prone to stroke, such as the elderly.However, the long-term clinical superiority and cost-effectiveness of PTCA compared with thrombolytictherapy remains to be established’.
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Inpharma 10 Jan 1998 No. 11191173-8324/10/1119-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved