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 Primary Percutaneous Coronary Intervention Compared With Fib

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Number of posts : 203
Location : nepal
Registration date : 2007-09-19

PostSubject: Primary Percutaneous Coronary Intervention Compared With Fib   Fri Sep 21, 2007 12:10 am

Primary Percutaneous Coronary Intervention Compared With Fibrinolysis for Myocardial Infarction in Diabetes Mellitus



Results From the Primary Coronary Angioplasty vs Thrombolysis–2 Trial



Jorik R. Timmer, MD, PhD; Jan Paul Ottervanger, MD, PhD; Menko-Jan de
Boer, MD, PhD; Eric Boersma, PhD; Cindy L. Grines, MD; Cynthia M.
Westerhout, MD; R. John Simes, MD, FRACP; Christopher B. Granger, MD;
Felix Zijlstra, MD, PhD; for the Primary Coronary Angioplasty vs
Thrombolysis–2 Trialists Collaborators Group



Arch Intern Med. 2007;167:1353-1359.



Background There is growing evidence for a clinical benefit of
primary percutaneous coronary intervention (PCI) compared with
fibrinolysis; however, whether the treatment effect is consistent among
patients with diabetes mellitus is unclear. We compared PCI with
fibrinolysis for treatment of ST-segment elevation myocardial
infarction in patients with diabetes mellitus.



Methods
A pooled analysis of individual patient data from
19 trials comparing primary PCI with fibrinolysis for treatment of
ST-segment elevation myocardial infarction was performed. Trials that
enrolled at least 50 patients with ST-segment elevation myocardial
infarction and randomized patients to receive either primary PCI or
fibrinolysis were considered for inclusion in our study. Clinical end
points were total deaths, recurrent infarction, death or nonfatal
recurrent infarction, and stroke, measured 30 days after randomization.



Results Of 6315 patients, 877 (14%) had diabetes. Thirty-day
mortality (9.4% vs 5.9%; P < .001) was higher in patients with
diabetes. Mortality was lower after primary PCI compared with
fibrinolysis in both patients with diabetes (unadjusted odds ratio,
0.49; 95% confidence interval, 0.31-0.79; P = .004) and without
diabetes (unadjusted odds ratio, 0.69; 95% confidence interval,
0.54-0.86, P = .001), with no evidence of heterogeneity of treatment
effect (P = .24 for interaction). Recurrent infarction and stroke were
also reduced after primary PCI in both patient groups. After
multivariable analysis, primary PCI was associated with decreased
30-day mortality in patients with and without diabetes, with a point
estimate of greater benefit in diabetic patients.



Conclusions Diabetic patients with ST-segment elevation
myocardial infarction treated with reperfusion therapy have increased
mortality compared with patients without diabetes. The beneficial
effects of primary PCI compared with fibrinolysis in diabetic patients
are consistent with effects in nondiabetic patients.





Author Affiliations: Department of Cardiology, Isala Klinieken,
Zwolle, the Netherlands (Drs Timmer, Ottervanger, and de Boer);
Clinical Epidemiology Unit, Thoraxcenter, Erasmus Medical Center,
Rotterdam, the Netherlands (Drs Boersma and Westerhout); William
Beaumont Hospital, Royal Oak, Michigan (Dr Grines); Department of
Medicine, University of Alberta, Edmonton (Dr Westerhout); National
Health and Medical Research Counsel Clinical Trials Centre, University
of Sydney, Sydney, Australia (Dr Simes); Duke Clinical Research
Institute, Durham, North Carolina (Dr Granger); and Department of
Cardiology, Thoraxcenter, University Medical Center Groningen,
Groningen, the Netherlands (Dr Zijlstra).
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