European Heart Journal Advance Access originally published online on March 2, 2006
European Heart Journal 2006 27(7):761-763; doi:10.1093/eurheartj/ehi775
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Selection of the optimal reperfusion strategy for STEMI: does time matter?
1Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
2Samuel A. Levine Cardiac Unit, Harvard Medical School, Brigham and Women's Hospital, Cardiovascular Division, 75 Francis Street, Boston, MA 02115, USA
* Corresponding author. Tel: +1 507 284 4139; fax: +1 507 266 0103.E-mail address: gersh.bernard@mayo.edu
This editorial refers to ‘Does time matter? A pooled analysis of randomized clinical trials comparing primary percutaneous coronary intervention and in-hospital fibrinolysis in acute myocardial infarction patients’
by E. Boersma et al., on page 779
| The first 150 words of the full text of this article appear below. |
The comprehensive meta-analysis of 25 trials comparing the efficacy of primary percutaneous coronary intervention (PPCI) vs. fibrinolytic (FT) drugs in patients with ST-segment elevation acute myocardial infarction reported by Boersma et al.1 is a significant contribution to the literature. Strengths of this meta-analysis are the large amount of individual patient data from 22 trials and the rigorous statistical methodologies. The conclusions support and update prior analyses that suggest that ‘all things being equal,’ PPCI is the superior reperfusion strategy,2 provided this is carried out in the right institution, by the right operator; in some centres, the day of the week and the time of day may also be relevant.3 The authors argue (and this is a very controversial point) that irrespective of the delay between symptoms and presentation, PPCI is superior to fibrinolysis, although the absolute reduction in mortality by PPCI widens over time, consistent with the hypothesis that older thrombi
Selection of optimal therapeutic strategies in community hospitals without facilities for PPCI
Duration of symptoms
Haemodynamic instability
Risk of bleeding
Transport delays
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Related articles in EHJ:
- Does time matter? A pooled analysis of randomized clinical trials comparing primary percutaneous coronary intervention and in-hospital fibrinolysis in acute myocardial infarction patients
- Eric Boersma and The Primary Coronary Angioplasty vs. Thrombolysis (PCAT)-2 Trialists' Collaborative Group
EHJ 2006 27: 779-788.[Abstract] [FREE Full Text]
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