Assessing the effectiveness of primary angioplasty compared with thrombolysis and its relationship to time delay: a Bayesian evidence synthesis

Assenburg, C., Bravo-Vergel, Y., Palmer, S., Fenwick, E., de Belder, M., Abrams, K.R. and Sculpher, M. (2007) Assessing the effectiveness of primary angioplasty compared with thrombolysis and its relationship to time delay: a Bayesian evidence synthesis. Heart, 93, pp. 1244-1250. (doi: 10.1136/hrt.2006.093336)

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Publisher's URL: http://dx.doi.org/10.1136/hrt.2006.093336

Abstract

<i>Background</i>: Meta-analyses of trials have shown greater benefits from angioplasty than thrombolysis after an acute myocardial infarction, but the time delay in initiating angioplasty needs to be considered. <i>Objective</i>: To extend earlier meta-analyses by considering 1- and 6-month outcome data for both forms of reperfusion. To use Bayesian statistical methods to quantify the uncertainty associated with the estimated relationships. <i>Methods</i>: A systematic review and meta-analysis published in 2003 was updated. Data on key clinical outcomes and the difference between time-to-balloon and time-to-needle were independently extracted by two researchers. Bayesian statistical methods were used to synthesise evidence despite differences between reported follow-up times and outcomes. Outcomes are presented as absolute probabilities of specific events and odds ratios (ORs; with 95% credible intervals (CrI)) as a function of the additional time delay associated with angioplasty. <i>Results</i>: 22 studies were included in the meta-analysis, with 3760 and 3758 patients randomised to primary angioplasty and thrombolysis, respectively. The mean (SE) angioplasty-related time delay (over and above time to thrombolysis) was 54.3 (2.2) minutes. For this delay, mean event probabilities were lower for primary angioplasty for all outcomes. Mortality within 1 month was 4.5% after angioplasty and 6.4% after thrombolysis (OR = 0.68 (95% CrI 0.46 to 1.01)). For non-fatal reinfarction, OR = 0.32 (95% CrI 0.20 to 0.51); for non-fatal stroke OR = 0.24 (95% CrI 0.11 to 0.50). For all outcomes, the benefit of angioplasty decreased with longer delay from initiation. <i>Conclusions</i>: The benefit of primary angioplasty, over thrombolysis, depends on the former’s additional time delay. For delays of 30–90 minutes, angioplasty is superior for 1-month fatal and non-fatal outcomes. For delays of around 90 minutes thrombolysis may be the preferred option as assessed by 6-month mortality; there is considerable uncertainty for longer time delays.

Item Type:Articles
Keywords:Acute myocardial infarction, primary coronary angioplasty, thrombolytics, meta-regression.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Fenwick, Professor Elisabeth
Authors: Assenburg, C., Bravo-Vergel, Y., Palmer, S., Fenwick, E., de Belder, M., Abrams, K.R., and Sculpher, M.
Subjects:R Medicine > R Medicine (General)
R Medicine > RC Internal medicine
College/School:College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Centre for Population and Health Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Health Economics and Health Technology Assessment
Journal Name:Heart
Publisher:BMJ Publishing Group
ISSN:1355-6037
Copyright Holders:Copyright © 2007 BMJ Publishing Group
First Published:First published in Heart 93:1244-1250
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher.

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