on June 8, 2009
Published online before print June 8, 2009, doi: 10.1161/CIRCULATIONAHA.108.793745
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Submitted on May 22, 2008
From the McGill Health University Center (T.H.) and Department of Epidemiology and Biostatistics (L.J.), McGill University, Montreal; Direction of Public Health of Montreal (S.P.), Department of Social and Preventive Medicine (J.O.), and Montreal Heart Institute (P.T.), University of Montreal, Montreal; Department of Family Medicine, Laval University, Quebec (M.L.); and Institute for Clinical Evaluative Sciences, University of Toronto, Toronto (J.V.T.), Canada. * To whom correspondence should be addressed. E-mail: thao.huynhthanh{at}mail.mcgill.ca.
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 ( 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.
Accepted on April 17, 2009
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
Thao Huynh MD, MSC, FRCPC*,
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 (
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.
Key words: angioplasty • coronary disease • fibrinolysis • myocardial infarction • percutaneous coronary intervention • thrombolysis
Related Articles:
Circulation 2009 119: 3041-3043.
Circulation 2009 119: 3047-3049.
This article has been cited by other articles:
 |
|
 |
|
  F. W.A. Verheugt Reperfusion Therapy for ST-Segment Elevation Myocardial Infarction: Trials, Registries, and Guidelines Circulation, June 23, 2009; 119(24): 3047 - 3049. [Full Text] [PDF]
|
|