1
Inpharma 1119 - 10 Jan 1998 Primary PTCA superior to Table. Meta-analysis results of trials involving thrombolysis in acute MI? patients with suspected MI according to treatment Patients Thrombolytic Primary percutaneous transluminal coronary undergoing therapy recipients angioplasty (PTCA) appears to be superior to primary PTCA thrombolysis in terms of short-term outcomes in Overall mortality patients with acute myocardial infarction (MI), report a rate (percentage of multinational 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 and The researchers conducted a meta-analysis of 10 nonfatal randomised trials (including the GUSTO-IIb study * ) reinfarction involving 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 11.9 patients who were randomised to receive thrombolytic Rate of nonfatal therapy, 307 received streptokinase, 300 received a 3–4 reinfarction (percentage of hour infusion of alteplase [t-PA], and 709 received an patients): accelerated alteplase regimen. 5.4 2.8 Reduced risk of death Rate of total stroke (percentage of Meta-analysis revealed that at the end of the study patients): period in all trials (30 days), there was a significant 0.7 2 reduction in the risk of death among patients who Rate of received primary PTCA compared with thrombolysis haemorrhagic (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 nonfatal reinfarction was lower in patients who underwent * See Inpharma 1091: 12, 14 Jun 1997; 800538081 primary PTCA compared with thrombolysis. This represents 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 with JAMA: the Journal of the American Medical Association 278: 2093-2098, 17 thrombolysis. Dec 1997. However, the rate of nonfatal reinfarction alone was 2. Yusuf S, et al. Primary angioplasty compared with thrombolytic therapy for acute myocardial infarction. JAMA: the Journal of the American Medical lower among thrombolytic therapy recipients compared Association 278: 2110-2111, 17 Dec 1997. with patients who underwent PTCA. The rates of total 800458992 stroke and haemorrhagic stroke were significantly lower among patients who underwent PTCA compared with those 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 reinfarction rates achieved with PTCA ‘are promising but not conclusive and the real benefits may well be smaller’. 2 They add that ‘ideally, we need well-designed and larger trials conducted in a broad range of hospitals in the community’. Dr Yusuf and Ms Pogue conclude that ‘direct PTCA is at least a reasonable alternative to thrombolytic therapy in high-risk patients, and in expert hands, may be preferred in patients prone to stroke, such as the elderly. However, the long-term clinical superiority and cost- effectiveness of PTCA compared with thrombolytic therapy remains to be established’. 1 Inpharma 10 Jan 1998 No. 1119 1173-8324/10/1119-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

Primary PTCA superior to thrombolysis in acute MI?

  • View
    215

  • Download
    1

Embed Size (px)

Citation preview

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’.

1

Inpharma 10 Jan 1998 No. 11191173-8324/10/1119-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved