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

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Studies were selected if they were published or unpublished randomised controlled trials (RCTs) comparing primary PTCA with intravenous thrombolytic treatment for acute ST segment MI.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