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 |
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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 > School of Health & 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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