Articles found in ? language using The Cochrane Library (Issue 2, 1998), MEDLINE, to January 1998 (search terms: coronary angioplasty, transluminal balloon or percutaneous transluminal coronary angioplasty or PTCA and myocardial infarction or thrombolytic agents or alteplase or ancrod or anistreplase or brinopase or plasminogen or plasminogen activators or reptilase or streptokinase or urokinase or fibrinolytic agents ) and references from reviews, trials and previously published meta-analysis and contacting experts.

Selection criteria: as above
Appraisal criteria: detailed in text
Articles excluded if: no clinical outcomes

Ten trials were included.
There was no significant heterogeneity.

The evidence

Myocardial infarction: primary angioplasty decreases death and stroke.

Clinical bottom line (level 1a)

  1. Patients with acute myocardial infarction who are given primary angioplasty are less likely to die than those given intravenous thrombolysis (NNT = 70 at unknown) .
  2. Patients given primary angioplasty are less likely to have a stroke than those given intravenous thrombolysis (NNT = 203 at unknown) .
  3. There is no clear difference in major bleeding or need for coronary artery bypass grafting between the two groups.
Cucherat et al: The Cochrane Library, Issue 2, Oxford: Update Software 1999; 2: -
Expires December 2003

The study

Systematic review of randomised trials of
  • Patients: suspected acute myocardial infarction
  • Intervention: primary balloon angioplasty without stenting compared with intravenous fibrinolytic therapy
  • Outcome: death at the end of the study


    • Articles found in ? language using The Cochrane Library (Issue 2, 1998), MEDLINE, to January 1998 (search terms: coronary angioplasty, transluminal balloon or percutaneous transluminal coronary angioplasty or PTCA and myocardial infarction or thrombolytic agents or alteplase or ancrod or anistreplase or brinopase or plasminogen or plasminogen activators or reptilase or streptokinase or urokinase or fibrinolytic agents ) and references from reviews, trials and previously published meta-analysis and contacting experts.

    Selection criteria: as above
    Appraisal criteria: detailed in text
    Articles excluded if: no clinical outcomes

    Ten trials were included.
    There was no significant heterogeneity.

    The evidence

    Outcome Time to outcome CER OR
    (95% CI)    		 NNT
    (95% CI)
    mortality weeks 57/1273
    (4.48%)    		 0.67
    (0.48 to 0.94)     		70
    (44 to 388)
    stroke unknown 8/1052
    (0.76%)    		 0.35
    (0.18 to 0.68)     		203
    (161 to 413)
    major bleeding unknown 35/962
    (3.64%)    		 1.19
    (0.72 to 1.95)     		-151
    (NNT = 101 to infinity;
    NNH = 31 to infinity)
    coronary artery bypass grafting unknown 29/337
    (8.61%)    		 0.68
    (0.42 to 1.10)     		39
    (NNT = 21 to infinity;
    NNH = 128 to infinity)

    Comments

    1. The systematic use of stenting and of anti-Gp2b3a agents was not evaluated since they were not used in the included studies, therefore the PTCA technology analysed is partially outdated.

    Citation

    1. Cucherat M, Bonnefoy E, Tremeau G: Primary angioplasty versus intravenous thrombolysis for acute myocardial infarction. The Cochrane Library, Issue 2, Oxford: Update Software 1999; 2: -
    Contributor: Nick Shenker and Clare Wotton, December 1999
    Reviewer: William Rhoton

    Clinical Question.
    Patient acute myocardial infarction
    Intervention or Exposure primary balloon angioplasty
    Comparison fibrinolytic therapy
    Outcome death
Outcome Time to outcome CER OR
(95% CI)		 NNT
(95% CI)
mortality weeks 57/1273
(4.48%)		 0.67
(0.48 to 0.94) 		70
(44 to 388)
stroke unknown 8/1052
(0.76%)		 0.35
(0.18 to 0.68) 		203
(161 to 413)
major bleeding unknown 35/962
(3.64%)		 1.19
(0.72 to 1.95) 		-151
(NNT = 101 to infinity;
NNH = 31 to infinity)
coronary artery bypass grafting unknown 29/337
(8.61%)		 0.68
(0.42 to 1.10) 		39
(NNT = 21 to infinity;
NNH = 128 to infinity)

Comments

  1. The systematic use of stenting and of anti-Gp2b3a agents was not evaluated since they were not used in the included studies, therefore the PTCA technology analysed is partially outdated.

Citation

  1. Cucherat M, Bonnefoy E, Tremeau G: Primary angioplasty versus intravenous thrombolysis for acute myocardial infarction. The Cochrane Library, Issue 2, Oxford: Update Software 1999; 2: -
Contributor: Nick Shenker and Clare Wotton, December 1999
Reviewer: William Rhoton

Clinical Question.
Patient acute myocardial infarction
Intervention or Exposure primary balloon angioplasty
Comparison fibrinolytic therapy
Outcome death