BACKGROUND: Intravenous thrombolytic therapy is the standard care for @entity1 with @entity583 , based upon its widespread availability and ability to reduce @entity1 mortality well demonstrated in randomised trials. Despite its proven efficacy, thrombolytic therapy has limitations. Many @entity1 are ineligible for treatment with thrombolytics. Of those given thrombolytic therapy, 10 to 15 percent have persistent @entity432 or reocclusion of the @entity1188 . Consequently, primary angioplasty (primary PTCA) has been advocated as a better treatment of @entity583 . OBJECTIVES: To determine whether primary coronary angioplasty is superior to thrombolytic therapy for the treatment of @entity1 with @entity583 . SEARCH STRATEGY: Electronic search of The Cochrane Library (1998; Issue 2). MEDLINE (to January 1998); references from reviews, trials and previously published meta-analyses; and experts. Date of most recent searches January 1998. SELECTION CRITERIA: All unconfounded, randomised controlled trials comparing primary angioplasty against @entity5275 in @entity1 with @entity583 DATA COLLECTION AND ANALYSIS: At least two independent reviewers abstracted data on morbidity and mortality and trial characteristics. The following outcomes were assessed: total mortality at the end of the study, reinfarction, @entity64 of any type, composite endpoint of death and reinfarction, recurrent @entity63 , severe @entity548 and coronary artery bypass grafting. MAIN RESULTS: Ten trials including 2573 subjects were identified. Compared to thrombolytic therapy, primary angioplasty was associated with a significant reduction in short-term mortality at the end of the studies (relative reduction in risk RRR = 32% 95%CI = 5%;50%). Similar reductions were observed for the rate of reinfarction (RRR = 52%, 95%CI = 30%;67%), recurrent @entity63 (RRR = 54%; 95%CI = 39%,66%) and for the combined criteria death or reinfarction (RRR = 46%; 95%CI=30%;58%). The frequency of strokes of any cause was significantly decreased by 66% (95%CI=28%;84%). No significant difference was observed for the incidence of major @entity548 (relative risk RR =1.18, 95%CI = 0.73;1.90) but the confidence interval was large. The superiority of the primary angioplasty over thrombolysis in terms of the composite endpoint (mortality and reinfarction) was less with accelerated @entity3479 (RR=0.70, 95%CI=0.51;0.97) than with streptokinase (RR=0.30, 95%CI=0.17;0.53). The biggest and most recent trial, Gusto 2B (GUSTO-2B 97), which involved general as well as highly specialised centres, obtained less favorable results. REVIEWER'S CONCLUSIONS: This meta-analysis suggests that angioplasty provides a short-term clinical advantage over thrombolysis which may not be sustained. Primary angioplasty when available promptly at experienced centres, may be considered the preferred strategy for myocardial reperfusion. In most situations, however, optimal thrombolytic therapy should still be regarded as an excellent reperfusion strategy.

Primary angioplasty versus @entity5275 for XXXX .

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity64 :: ('MESH:D020521', 'Disease') :: ['stroke'] @entity5275 :: ('MESH:D015819', 'Disease') :: ['intravenous thrombolysis'] @entity63 :: ('MESH:D007511', 'Disease') :: ['ischemia'] @entity548 :: ('MESH:D006470', 'Disease') :: ['bleeding'] @entity1188 :: ('MESH:D007238', 'Disease') :: ['infarct-related artery'] @entity432 :: ('MESH:D001157', 'Disease') :: ['occlusion'] @entity583 :: ('MESH:D009203', 'Disease') :: ['myocardial infarction', 'acute myocardial infarction'] @entity3479 :: ('5327', 'Gene') :: ['t-PA']
@entity583 :: (MESH:D009203,Disease) :: ['acute myocardial infarction']
