Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials
Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials
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DOI：
10.1016/s0140-6736(03)12113-7
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发表时间：
2003-01-04
期刊：
影响因子：
168.9
通讯作者：
Grines, CL
中科院分区：
文献类型：
--
作者：
Keeley, EC;Boura, JA;Grines, CL
背景：许多临床试验比较了直接经皮冠状动脉腔内成形术（PTCA）和溶栓治疗急性ST段抬高心肌梗死（AMI）的疗效。我们的目的是看看这些试验的综合结果，并确定再灌注治疗是最有效的。方法我们做了一个搜索发表的工作，并确定了23项试验，一起随机分配7739溶栓合格的ST段抬高急性心肌梗死患者直接PTCA（n=3872）或溶栓治疗（n=3867）。在8项试验中使用了链激酶（n=1837），在15项试验中使用了纤维蛋白特异性药物（n=5902）。大多数接受溶栓治疗的患者（76%，n=2939）接受了纤维蛋白特异性药物。在12项试验中使用了支架，在8项试验中使用了血小板糖蛋白IIb/IIIa抑制剂。我们确定了死亡、非致命性再梗死和卒中的短期和长期临床结局，并进行了亚组分析，以评估所用溶栓药物类型和急诊医院转移策略对直接PTCA的影响。所有的分析都包括了SHOCK试验的数据，结果显示直接PTCA在降低总体短期死亡率方面优于溶栓治疗（7% [n=270] vs 9% [360]; p=0.0002），死亡，不包括SHOCK试验数据（5% [199] vs 7% [276]; p=0.0003），非致死性再梗死（3% [80] vs 7% [222]; p
Background Many trials have been done to compare primary percutaneous transluminal coronary angioplasty (PTCA) with thrombolytic therapy for acute ST-segment elevation myocardial infarction (AMI). Our aim was to look at the combined results of these trials and to ascertain which reperfusion therapy is most effective.Methods We did a search of published work and identified 23 trials, which together randomly assigned 7739 thrombolytic-eligible patients with ST-segment elevation AMI to primary PTCA (n=3872) or thrombolytic therapy (n=3867). Streptokinase was used in eight trials (n=1837), and fibrin-specific agents in 15 (n=5902). Most patients who received thrombolytic therapy (76%, n=2939) received a fibrin-specific agent. Stents were used in 12 trials, and platelet glycoprotein IIb/IIIa inhibitors were used in eight. We identified short-term and long-term clinical outcomes of death, non-fatal reinfarction, and stroke, and did subgroup analyses to assess the effect of type of thrombolytic agent used and the strategy of emergent hospital transfer for primary PTCA. All analyses were done with and without inclusion of the SHOCK trial data.Findings Primary PTCA was better than thrombolytic therapy at reducing overall short-term death (7% [n=270] vs 9% [360]; p=0.0002), death excluding the SHOCK trial data (5% [199] vs 7% [276]; p=0.0003), non-fatal reinfarction (3% [80] vs 7% [222]; p