Myocardial infarction: fewer patients need revascularisation following primary stenting compared with balloon angioplasty

Clinical bottom line (level 1a)

  1. Patients with an acute myocardial infarction who undergo primary coronary artery stenting compared with balloon angioplasty are less likely to require target vessel revascularisation (NNT = 10 at 6 months) .
  2. Patients receiving stenting are not clearly more likely to die or reinfarct.
Zhu et al: Am J Cardiol 2001; 88 : 297-301
Expires March 2004

The study

Systematic review of all randomised trials of
  • Patients: acute myocardial infarction
  • Intervention: primary coronary artery stenting compared with primary balloon angioplasty
  • Outcome: death, myocardial infarction, target vessel revascularisation
Articles found in ?English using Medline, 1990 to December 2000 (search terms: ) and searching the scientific session abstracts in Circulation, J Am Coll Cardiol, Eur Heart J from 1995 to 2000. Reference lists of identified trials and reviews were also searched.

Selection criteria: see above and below
Appraisal criteria: Only intention-to-treat analysis reported. Original authors were contacted to retrieve missing data.
Articles excluded if:
  • < 6 months follow-up
  • insufficient data to use in meta-analysis


9 RCTs found involving 4120 patients.
Studies were not found to be significantly heterogeneous.

The evidence

Outcome Time to outcome CER OR
(95% CI)		 NNT
(95% CI)
death 6 months 75/2070
(3.6%)		 1.04
(0.75 to 1.44) 		-720
(NNT = 110 to infinity;
NNH = 66 to infinity)
reinfarction 6 months 60/2070
(2.9%)		 0.71
(0.47 to 1.08) 		120
(NNT = 66 to infinity;
NNH = 450 to infinity)
target vessel revascularisation 6 months 387/2070
(18.7%)		 0.43
(0.36 to 0.52) 		10
(9 to 12)
major adverse cardiac events 6 months 466/2070
(22.5%)		 0.52
(0.44 to 0.62) 		11
(9 to 14)

Comments

  1. Many studies excluded patients with cardiogenic shock. Only one routinely gave glycoprotein IIb/IIIa platelet inhibitors.

Citation

  1. Zhu MM, Feit A, Chadow H, et al: primary stent implantation compared with primary balloon angioplasty for acute myocardial infarction: a meta-analysis of randomized clinical trials. Am J Cardiol 2001; 88 : 297-301
Search Terms: from ACP Journal Club
Contributor: Chris Ball, March 2002
Reviewer:

Clinical Question.
Patient acute myocardial infarction
Intervention or Exposure coronary artery stenting
Comparison balloon angioplasty
Outcome death, myocardial infarction, target vessel revascularisation