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MI: PTCA SAVES MORE LIVES (AT 6 WEEKS) THAN THROMBOLYSIS

Clinical Bottom Line
PTCA decreases short term mortality (6 wk) in pts with acute MI compared to thrombolysis but sufficient data on long term use is not available.

Appraised by: S Straus, 1996

Question:
In a pt with suspected MI, does PTCA decrease mortality compared to thrombolysis?

Search Terms:
PTCA, myocardial infarction in Best Evidence

The Study
* systematic review of 7 trials of primary PTCA
* included RCTs of PTCA with endpoints of mortality and reinfarction

The Evidence

Event OR NNT(if PEER* is 9.5%)

Mortality at 6 wks .56 (.33-.94) 24

Event	OR	NNT(if PEER* is 9.5%)
Mortality at 6 wks	.56 (.33-.94)	24

Comments:

*PEER is Patient Expected Event (death) Rate at 6 weeks
long term data not available from enough pts to provide reliable estimates beyond 6 wks
addition of PTCA to thrombolysis does not improve clinical outcomes
applicability is limited by the availability of 'round-the-clock PTCA
did not include cost or cost-effectiveness of PTCA

Name: Sharon Straus

Expiry Date: 1998

Reference:

Michels KB, Yusuf S. Does PTCA in acute MI affect mortality and reinfarction rates? A quantitative overview of the randomised clinical trials. Circulation 1995;91:123-8.

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