Primary Angioplasty Compared With Thrombolytic Therapy for Acute Myocardial Infarction

Abstract

In this issue ofThe Journal, Weaver and colleagues1provide a careful quantitative review of the available data from randomized trials comparing primary percutaneous transluminal coronary angioplasty (PTCA) with thrombolytic therapy in patients with acute myocardial infarction. This analysis of 10 trials includes 2606 patients and reports a reduction in mortality (odds ratio, 0.66; 95% confidence interval [CI], 0.46-0.94), in the composite of mortality and reinfarction (odds ratio, 0.58; 95% CI, 0.44-0.76), and in stroke (odds ratio, 0.35; 95% CI, 0.14-0.77) with the use of PTCA. However, before the data from these analyses are considered persuasive enough to conclusively establish the superiority of primary PTCA over thrombolytic therapy, 3 key questions must be addressed. See also p 2093. First, are there potential biases that could have inflated the results of the individual trials or this meta-analysis? Several potential biases both within each trial and in the authors' metaanalysis should