The Big Heart Disease Lie

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1 Antman EM, Giugliano RP, Gibson CM, et al for the TIMI 14 Investigators. Abciximab facilitates the rate and extent of thrombolysis: results of the thrombolysis in myocardial infarction (TIMI) 14 trial. Circulation 1999;99:2720-32.

2 Brener SJ, Barr LA, Burchenal J, et al. Randomized, placebo-controlled trial of platelet glycoprotein IIb-IIIa blockade with primary angioplasty for acute myocardial infarction. The RAPPORT trial. Circulation 1998;98:734-41

3 Ross AM, Coyne KS, Reiner JS, et al for the PACT Investigators. A randomized trial comparing primary angioplasty with a strategy of short-acting thrombolysis and immediate planned rescue angioplasty in acute myocardial infarction: the PACT trial. JAm Coll Cardiol 1999;34:1954-62.

4 Franzosi MG, Santoro E, De Vita C, et al, on behalf of the GISSI Investigators. Ten-year follow-up of the first megatrial testing thrombolytic therapy in patients with acute myocardial infarction. Circulation 1998;98:2659-65.

5 GUSTO Investigators. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. NEnglJMed 1993;329:673-82.

► Large reperfusion trial that showed a significant (14.6%) risk reduction in mortality with rt-PA and heparin compared to streptokinase.

6 GUSTO V Investigators. Reperfusion therapy for acute myocardial infarction with fibrinolytic therapy or combination reduced fibrinolytic therapy and platelet glycoprotein IIb/IIIa inhibition: the GUSTO V randomised trial. Lancet 2001;357:1905-14.

► The most recent megatrial of infusive reperfusion treatment in AMI that compared standard fibrinolysis with reteplase versus half dose of reteplase plus full dose of abciximab. The study showed identical mortality rates with both treatments.

7 GUSTO II-b Angioplasty Substudy Investigators. A clinical trial comparing primary coronary angioplasty with tissue plasminogen activator for acute myocardial infarction. N Engl J Med 1997;336:1621-8.

► The largest randomised trial that compared primary angioplasty with accelerated rt-PA in AMI in community hospitals. The advantages of primary angioplasty were marginal and not sustained at six months.

8 Hochman JS, Sleeper LA, Webb JG, et al for the SHOCK Investigators. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. N Engl J Med 1999;341:625-34.

9 Tiefenbrunn AJ, Chandra NC, French WJ, et al. Clinical experience with primary transluminal coronary angioplasty compared with alteplase (recombinant tissue-type plasminogen activator) in patients with acute myocardial infarction: a report from the second national registry of myocardial infarction (NRMI-2). JAm Coll Cardiol 1998;31:1240-5.

► National registry that analyses the clinical outcome of 272 651 patients with AMI presenting at US hospitals. Very low percentage of patients eligible for reperfusion therapy (31%); similar results with lysis and angioplasty. Angioplasty is superior in patients presenting in cardiogenic shock.

10 Weaver DW, Simes JR, Betriu A, et al. Comparison of primary coronary angioplasty and intravenous thrombolytic therapy for acute myocardial infarction. A quantitative review. JAMA 1997;278:2093-8.

► Meta-analysis of all available randomised trials that compared fibrinolysis and primary angioplasty. The invasive strategy significantly reduces mortality by 32%.

11 Schomig A, Kastrati A, Dirschinger J, et al for the Stent versus Thrombolysis for Occluded Coronary Arteries in Patients with Acute Myocardial Infarction Study Investigators. Coronary stenting plus platelet glycoprotein IIb/IIIa blockade compared with tissue plasminogen activator in acute myocardial infarction. N Engl J Med 2000;343:385-91.

12 Montalescot G, Barragan P, Wittenberg O, et al. Platelet glycoprotein IIb/IIIa inhibition with coronary stenting for acute myocardial infarction. N Engl J Med 2001;344:1895-903.

13 White HD. Future of reperfusion therapy for acute myocardial infarction. Lancet 1999;354:695-7.

► Brief but complete summary of recent trials and thoughtful considerations about the future of reperfusion treatment.

14 Brodie BR. When should patients with acute myocardial infarction be transferred for primary angioplasty? [editorial]. Heart 1997;78:327-8.

► Comparison of differences of outcome according to time to reperfusion with primary angioplasty or fibrinolysis from the extrapolation of data from PAMI and GUSTO I trials respectively.

15 GUSTO Angiographic Investigators. The effects of tissue plasminogen activator, streptokinase, or both on coronary-artery patency, ventricular function and survival after acute myocardial infarction. N Engl J Med 1993;329:1615-22.

16 Zijlstra F, Hoorntje JCA, de Boer MJ, et al. Long-term benefit of primary angioplasty as compared with thrombolytic therapy for acute myocardial infarction. N Engl J Med 1999;341:1413-19.

► Impressive demonstration of the superiority of primary angioplasty over fibrinolysis on survival at long term follow up (5±2 years).

17 Venturini F, Romero M, Tognoni G. Patterns of practice for acute myocardial infarction in a population from ten countries. Eur J Clin Pharmacol 1999;54:877-86.

18 Lincoff AM, Topol EJ. Illusion of reperfusion. Does anyone achieve optimal reperfusion during acute myocardial infarction?. Circulation 1993;88:1361-74.

► Excellent editorial review that addresses the discrepancies between the complete degree of angiographic epicardial reperfusion and tissue reperfusion.

19 Parmley WW. Cost-effectiveness of reperfusion strategies. Am Heart J 1999;138:S142-6.

20 O'Neill WW. Coronary thrombosis during acute myocardial infarction: Roberts was right! Am J Cardiol 1998;82:896-7.

► Interesting observations about the non-thrombotic origin of a number of total acute coronary occlusions that may not be relieved by lytic agents.

Additional references appear on the Heart

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