0
December 17, 1997, Vol 278, No. 23 >
ARTICLE | December 17, 1997

Primary Angioplasty Compared With Thrombolytic Therapy for Acute Myocardial Infarction FREE

Salim Yusuf, FRCP, DPhil; Janice Pogue, MSc
[+] Author Affiliations

Corresponding author: Salim Yusuf, FRCP, DPhil, Hamilton General Hospital, 237 Barton St E,Hamilton, Ontario, Canada L8L 2×2(e-mail:yusufs@fhs.csu.mcmaster.ca).


JAMA. 1997;278(23):2110-2111. doi:10.1001/jama.1997.03550230086044
Text Size: A A A
Published online
Article
References

In this issue of The Journal, Weaver and colleagues1 provide a careful quantitative review of the available data from randomized trials comparing primary percutaneous transluminal coronary angioplasty (PTCA) with thrombolytic therapy in patients with acute myocardial infarction. This analysis of 10 trials includes 2606 patients and reports a reduction in mortality (odds ratio, 0.66; 95% confidence interval [CI], 0.46-0.94), in the composite of mortality and reinfarction (odds ratio, 0.58; 95% CI, 0.44-0.76), and in stroke (odds ratio, 0.35; 95% CI, 0.14-0.77) with the use of PTCA. However, before the data from these analyses are considered persuasive enough to conclusively establish the superiority of primary PTCA over thrombolytic therapy, 3 key questions must be addressed.

See also p 2093.

First, are there potential biases that could have inflated the results of the individual trials or this meta-analysis? Several potential biases both within each trial and in the authors' metaanalysis should

REFERENCES

1 +
Weaver WD, Simes RJ, Betriu A, et al.  Comparison of primary coronary angioplasty and intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review . JAMA . 1997;;278:2093-2098.
2 +
 The Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes GUSTO IIb Angioplasty Substudy Investigators. A clinical trial comparing primary coronary angioplasty with tissue plasminogen activator for acute myocardial infarction . N Engl J Med . 1997;;336:1621-1628.
3 +
Grines CL, Browne KF, Marco J, et al.  A comparison of immediate angioplasty with thrombolytic therapy for acute myocardial infarction . N Engl J Med . 1993;;328:673-679.
4 +
Michels KB, Yusuf S.  Does PTCA in acute myocardial infarction affect mortality and reinfarction rates? a quantitative overview (meta-analysis) of the randomized clinical trials . Circulation . 1995;;91:476-485.
5 +
Pogue J, Yusuf S. Overcoming the limitations of current meta-analysis of readomized controlled trials. Lancet. In press.
6 +
O'Neill W, Timmis GC, Bourdillon PD, et al.  A prospective randomized clinical trial of intracoronary streptokinase versus coronary angioplasty for acute myocardial infarction . N Engl J Med . 1986;;314:812-818.
7 +
Gibbons RJ, Holmes DR, Reeder GS, et al.  Immediate angioplasty compared with the administration of a thrombolytic agent followed by conservative treatment for myocardial infarction . N Engl J Med . 1993;;328:685-691.
8 +
Every N, Parsons L, Hlatky M, et al.  A comparison of thrombolytic therapy with primary coronary angioplasty for acute myocardial infarction . N Engl J Med . 1996;;335:1253-1260.
9 +
Volpi A, Maggioni A, Franzosi MG, et al.  In-hospital prognosis of patients with acute myocardial infarction complicated by primary ventricular fibrillation . N Engl J Med . 1987;;317:257-261.
10 +
Fibrinolytic Therapy Trialists' Collaborative Group.  Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomized trials of more than 1000 patients . Lancet . 1994;;343:311-322.
11 +
Macaya C, Serruys PW, Ruygrok P, et al.  Continued benefit of coronary stenting versus balloon angioplasty: one-year clinical follow-up of Benestent Trial: Benestent Study Group . J Am Coll Cardiol . 1996;;27:255-261.
12 +
The EPIC Investigators.  Use of a monoclonal antibody directed against the platelet glycoprotein IIb/IIIa receptor in high-risk coronary angioplasty . N Engl J Med . 1994;;330:956-961.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Weaver WD, Simes RJ, Betriu A, et al.  Comparison of primary coronary angioplasty and intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review . JAMA . 1997;;278:2093-2098.
2 +
 The Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes GUSTO IIb Angioplasty Substudy Investigators. A clinical trial comparing primary coronary angioplasty with tissue plasminogen activator for acute myocardial infarction . N Engl J Med . 1997;;336:1621-1628.
3 +
Grines CL, Browne KF, Marco J, et al.  A comparison of immediate angioplasty with thrombolytic therapy for acute myocardial infarction . N Engl J Med . 1993;;328:673-679.
4 +
Michels KB, Yusuf S.  Does PTCA in acute myocardial infarction affect mortality and reinfarction rates? a quantitative overview (meta-analysis) of the randomized clinical trials . Circulation . 1995;;91:476-485.
5 +
Pogue J, Yusuf S. Overcoming the limitations of current meta-analysis of readomized controlled trials. Lancet. In press.
6 +
O'Neill W, Timmis GC, Bourdillon PD, et al.  A prospective randomized clinical trial of intracoronary streptokinase versus coronary angioplasty for acute myocardial infarction . N Engl J Med . 1986;;314:812-818.
7 +
Gibbons RJ, Holmes DR, Reeder GS, et al.  Immediate angioplasty compared with the administration of a thrombolytic agent followed by conservative treatment for myocardial infarction . N Engl J Med . 1993;;328:685-691.
8 +
Every N, Parsons L, Hlatky M, et al.  A comparison of thrombolytic therapy with primary coronary angioplasty for acute myocardial infarction . N Engl J Med . 1996;;335:1253-1260.
9 +
Volpi A, Maggioni A, Franzosi MG, et al.  In-hospital prognosis of patients with acute myocardial infarction complicated by primary ventricular fibrillation . N Engl J Med . 1987;;317:257-261.
10 +
Fibrinolytic Therapy Trialists' Collaborative Group.  Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomized trials of more than 1000 patients . Lancet . 1994;;343:311-322.
11 +
Macaya C, Serruys PW, Ruygrok P, et al.  Continued benefit of coronary stenting versus balloon angioplasty: one-year clinical follow-up of Benestent Trial: Benestent Study Group . J Am Coll Cardiol . 1996;;27:255-261.
12 +
The EPIC Investigators.  Use of a monoclonal antibody directed against the platelet glycoprotein IIb/IIIa receptor in high-risk coronary angioplasty . N Engl J Med . 1994;;330:956-961.

Letters

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems