A COMPARISON OF RESULTS OF METAANALYSES OF RANDOMIZED CONTROL TRIALS AND RECOMMENDATIONS OF CLINICAL EXPERTS - TREATMENTS FOR MYOCARDIAL-INFARCTION
A COMPARISON OF RESULTS OF METAANALYSES OF RANDOMIZED CONTROL TRIALS AND RECOMMENDATIONS OF CLINICAL EXPERTS - TREATMENTS FOR MYOCARDIAL-INFARCTION
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DOI：
10.1001/jama.268.2.240
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发表时间：
1992-07-08
影响因子：
120.7
通讯作者：
CHALMERS, TC
中科院分区：
文献类型：
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作者：
ANTMAN, EM;LAU, J;CHALMERS, TC
目的：研究心肌梗死治疗的随机对照试验数据积累与撰写综述文章和教科书章节的临床专家所提建议之间的时间关系。
资料来源：（1）1966年至今的医学文献数据库（MEDLINE）检索；使用的检索词为心肌梗死、临床试验、多中心研究、双盲法、荟萃分析以及文本词“随机”；（2）相关文章和书籍的参考文献；（3）所有英文版的综合医学教材、手册以及关于心肌梗死治疗的综述文章。
研究选择：降低心肌梗死总死亡率风险的治疗方法的随机对照试验（急性和二级预防）。涉及心肌梗死患者一般临床管理的综述文章和教科书章节。
数据提取：两名作者阅读资料并记录结果；分歧通过讨论解决。
数据综合：我们使用累积荟萃分析技术（当一项新的临床试验结果发表时进行一次新的荟萃分析），并将结果与专家对心肌梗死各种治疗的建议进行比较。在随机试验的荟萃分析有效性模式与综述作者的建议之间发现了差异。综述文章常常未能提及重要进展，或在推荐有效预防措施方面存在延迟。在某些情况下，几种临床专家仍继续推荐对死亡率无影响或可能有害的治疗方法。
结论：查找和分析某一特定领域的所有治疗试验已成为一项如此困难和专业化的任务，以至于被要求及时总结证据的临床专家需要获取更好的数据库和新的统计技术来协助他们完成这一重要任务。
Objective.-To examine the temporal relationship between accumulating data from randomized control trials of treatments for myocardial infarction and the recommendations of clinical experts writing review articles and textbook chapters.Data Sources.-(1) MEDLINE search from 1966 to present; search terms used were myocardial infarction, clinical trials, multicenter studies, double-blind method, meta-analysis, and the text word "random:"; (2) references from pertinent articles and books; and (3) all editions of English-language general medical texts and manuals and review articles on treatment of myocardial infarction.Study Selection.-Randomized control trials of therapies for reducing the risk of total mortality in myocardial infarction (acute and secondary prevention). Review articles and textbook chapters dealing with the general clinical management of patients with myocardial infarction.Data Extraction.-Two authors read the material and recorded the results; disagreements were resolved by conference.Data Synthesis.-We used the technique of cumulative meta-analysis (performing a new meta-analysis when the results of a new clinical trial are published) and compared the results with the recommendations of the experts for various treatments for myocardial infarction. Discrepancies were detected between the meta-analytic patterns of effectiveness in the randomized trials and the recommendations of reviewers. Review articles often failed to mention important advances or exhibited delays in recommending effective preventive measures. In some cases, treatments that have no effect on mortality or are potentially harmful continued to be recommended by several clinical experts.Conclusions.-Finding and analyzing all therapeutic trials in a given field has become such a difficult and specialized task that the clinical experts called on to summarize the evidence in a timely fashion need access to better databases and new statistical techniques to assist them in this important task.