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Impact of Intravenous Thrombolysis on Short-term Coronary Revascularization RatesA Meta-analysis
C. David Naylor, MD, DPhil;
Susan B. Jaglal, MSc
JAMA. 1990;264(6):697-702.
Abstract
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Evidence of the potential impact of intravenous thrombolytic therapy on short-term revascularization rates among patients with acute myocardial infarction was sought. Because nonrandomized comparisons with conventional treatment would be subject to various confounders, a meta-analysis of randomized controlled trials was performed. Seven trials were included, applying standard doses of either tissue plasminogen activator or streptokinase without an aggressive revascularization protocol. Follow-up ranged from 14 to 30 days. The revascularization rates among treated patients in all trials were lower than in the conservative arm of the Thrombolysis in Myocardial Infarction Phase II trial, which established the current procedural benchmarks for postthrombolysis management. However, the aggregate volume of bypass surgery and angioplasty in patients treated with tissue plasminogen activator was more than double that of controls (odds ratio, 2.25; 95% confidence interval, 1.31 to 3.94), with a smaller but still significant increase for streptokinase-treated patients (odds ratio, 1.66; 95% confidence interval, 1.08 to 2.59). Combining all trials, the increase in mechanical revascularization was 80% (95% confidence interval, 33% to 144%). Thus, for patterns of practice currently accepted in North America, intravenous thrombolysis for myocardial infarction leads to a significant short-term increase in clinical and angiographic indications for revascularization as compared with conventional treatment.
(JAMA. 1990;264:697-702)
Author Affiliations
From the Clinical Epidemiology Unit, Sunnybrook Health Science Centre, North York, Canada, and the Departments of Medicine, Health Administration, and Behavioural Science, University of Toronto (Ontario) (Dr Naylor); and Graduate Department of Community Health, University of Toronto (Ms Jaglal).
Footnotes
Read in part before the Clinical Epidemiology and Health Care Section, National Meeting, American Federation for Clinical Research, Washington, DC, May 7, 1990.
The opinions expressed herein are those of the authors and should not be attributed to the Ontario Ministry of Health or Health and Welfare Canada.
Reprint requests to Clinical Epidemiology Unit A443, Sunnybrook Health Science Centre, 2075 Bayview Ave, North York, Ontario, Canada M4N 3M5 (Dr Naylor).
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