This Article Full Text Full Text (PDF) Data Supplement All Versions of this Article: 119/24/3101    most recent CIRCULATIONAHA.108.793745v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Google Scholar Articles by Huynh, T. Articles by Théroux, P. PubMed PubMed Citation Articles by Huynh, T. Articles by Théroux, P. Pubmed/NCBI databases Medline Plus Health Information Heart Attack Related Collections Cardiovascular Pharmacology Fibrinolysis Catheter-based coronary and valvular interventions: other Acute coronary syndromes Acute myocardial infarction Related Articles

(Circulation. 2009;119:3101-3109.)
© 2009 American Heart Association, Inc.

Interventional Cardiology

Comparison of Primary Percutaneous Coronary Intervention and Fibrinolytic Therapy in ST-Segment-Elevation Myocardial Infarction

Bayesian Hierarchical Meta-Analyses of Randomized Controlled Trials and Observational Studies

Thao Huynh, MD, MSC, FRCPC; Stephane Perron, MD, MSC, FRCPC; Jennifer O'Loughlin, PhD; Lawrence Joseph, PhD; Michel Labrecque, MD, PhD; Jack V. Tu, MD, PhD, FRCPC; Pierre Théroux, MD, FRCPC

From the McGill Health University Center (T.H.) and Department of Epidemiology and Biostatistics (L.J.), McGill University, Montreal; Direction of Public Health of Montreal (S.P.), Department of Social and Preventive Medicine (J.O.), and Montreal Heart Institute (P.T.), University of Montreal, Montreal; Department of Family Medicine, Laval University, Quebec (M.L.); and Institute for Clinical Evaluative Sciences, University of Toronto, Toronto (J.V.T.), Canada.

Reprint requests to Dr Thao Huynh, 1650 Ave Cedar, Room E-5200, Montreal, Quebec, H3G-1A4, Canada. E-mail thao.huynhthanh{at}mail.mcgill.ca

Received May 22, 2008; accepted April 17, 2009.

Background— Published meta-analyses comparing primary percutaneous coronary intervention with fibrinolytic therapy in patients with ST-segment-elevation myocardial infarction include only randomized controlled trials (RCTs). We aim to obviate the limited applicability of RCTs to real-world settings by undertaking meta-analyses of both RCTs and observational studies.

Methods and Results— We included all RCTs and observational studies, without language restriction, published up to May 1, 2008. We completed separate bayesian hierarchical random-effect meta-analyses for 23 RCTs (8140 patients) and 32 observational studies (185 900 patients). Primary percutaneous coronary intervention was associated with reductions in short-term (6-week) mortality of 34% (odds ratio, 0.66; 95% credible interval, 0.51 to 0.82) in randomized trials, and 23% lower mortality (odds ratio, 0.77; 95% credible interval, 0.62 to 0.95) in observational studies. Primary percutaneous coronary intervention was associated with reductions in stroke of 63% in RCTs and 61% in observational studies. At long-term follow-up (1 year), primary percutaneous coronary intervention was associated with a 24% reduction in mortality (odds ratio, 0.76; 95% credible interval, 0.58 to 0.95) and a 51% reduction in reinfarction (odds ratio, 0.49; 95% credible interval, 0.32 to 0.66) in RCTs. However, there was no conclusive benefit of primary percutaneous coronary intervention in the long term in the observational studies.

Conclusions— Compared with fibrinolytic therapy, primary percutaneous coronary intervention was associated with short-term reductions in mortality, reinfarction, and stroke in ST-segment-elevation myocardial infarction. Primary percutaneous coronary intervention was associated with long-term reductions in mortality and reinfarction in RCTs, but there was no conclusive evidence for a long-term benefit in mortality and reinfarction in observational studies.

---

 

CLINICAL PERSPECTIVE

Related Articles:

Circulation: Clinical Summaries
Circulation 2009 119: 3041-3043. [Extract] [Full Text]

Reperfusion Therapy for ST-Segment Elevation Myocardial Infarction: Trials, Registries, and Guidelines

Freek W.A. Verheugt
Circulation 2009 119: 3047-3049. [Extract] [Full Text]

This article has been cited by other articles:

				F. W.A. Verheugt Reperfusion Therapy for ST-Segment Elevation Myocardial Infarction: Trials, Registries, and Guidelines Circulation, June 23, 2009; 119(24): 3047 - 3049. [Full Text] [PDF]