Therapy

• if available offer primary angioplasty ^a with stenting ^a and abciximab ^a  

Why?

• It is more effective than thrombolysis (even tPA) - fewer patients die, have another infarction, recurrent ischaemia or a stroke. ^a
• There is no clear difference for major bleeding, subsequent need for bypass surgery, or long-term mortality. ^a
• Using stents reduces the need for subsequent revascularisation with clearly reducing death or reinfarction. ^a  
• Combining stenting with abciximab leads to fewer deaths, reinfarction or strokes than using alteplase ^a  or stenting alone, but increases the risk of minor bleeding. ^a

Primary angioplasty is more effective than thrombolysis at reducing death, reinfarction and stroke

Patient	Treatment	Comparison	Outcome	CER	OR (95% CI)	NNT (95% CI)
myocardial infarction a	primary angioplasty	thrombolysis	death at months	6.5%	0.67 (0.48 to 0.94)	49 (30 to 270)
			reinfarction at months	7.2%	0.47 (0.32 to 0.69)	27 (21 to 47)
			any stroke at months	2.4%	0.35 (0.18 to 0.68)	64 (50 to 130)
			recurrent ischaemia at months	15%	0.42 (0.31 to 0.57)	12 (10 to 17)

Primary stenting reduces the need for target vessel revascularisation

Patient	Treatment	Comparison	Outcome	CER	OR (95% CI)	NNT (95% CI)
myocardial infarction a	primary stenting	balloon angioplasty	target vessel revascularisation at 6 months	22.5%	0.43 (0.36 to 0.52)	10 (9 to 12)

Primary stenting with abciximab leads to fewer deaths, MIs or strokes than using tPA

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
myocardial infarction  a	primary stenting and abciximab	tPA	death, MI or stroke  at 6 months	23%	64% (12% to 85%)	7 (4 to 35)
myocardial infarction  a	primary stenting and abciximab	primary stenting alone	death, MI or revascularisation  at 6 months	34%	32% (2.2% to 53%)	9 (5 to 120)
			minor bleeding  at 6 months	3.3%	-270% (-860% to -39%)	-11 (-36 to -7)