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Therapeutics
Review: PTCA reduces adverse cardiac outcomes and death better than thrombolytics after myocardial infarction

https://doi.org/10.1136/ebm.8.4.108

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    (2003) Lancet 361, 13. Keeley EC, Boura JA, Grines CL.. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials.. ;. :. –20.
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 QUESTION: In patients with acute myocardial infarction (MI), is percutaneous transluminal coronary angioplasty (PTCA) more effective than thrombolytic treatment?

    Data sources

    Studies were identified by searching Medline, reviewing scientific session abstracts in the New England Journal of Medicine and 5 cardiology journals, and contacting authors.

    Study selection

    Studies were selected if they were published or unpublished randomised controlled trials (RCTs) comparing primary PTCA with intravenous thrombolytic treatment for acute ST segment MI.

    Data extraction

    Data were extracted on patient characteristics, symptom duration, use of stents or glycoprotein IIb/IIIa antagonists, thrombolytic agent used, time to treatment, and results. Outcomes included total mortality, reinfarction, stroke, haemorrhagic stroke, major bleeding, and a combined endpoint of death, reinfarction, and disabling stroke. Short term (4–6 wk) and long term (6–18 mo) effectiveness was assessed.

    Main results

    23 trials (n=7739) met the inclusion criteria. 8 trials compared PTCA with streptokinase (n=1837) and 15 compared PTCA with fibrin specific …

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    Footnotes

    • Source of funding: no external funding.

    • For correspondence: Dr E C Keeley, University of Texas Southwestern Medical Center, Dallas, TX, USA.Ellen.Keeley{at}UTSouthwestern.edu

    • Abstract and commentary also appear in ACP Journal Club.