Impact of intravenous thrombolysis on short-term coronary revascularization rates: a meta-analysis

Article Abstract:

An acute myocardial infarction (MI or heart attack) is caused by the occlusion of one or more of the coronary arteries, which supply blood to the heart muscle. Coronary artery occlusion may be due to a thrombus, or blood clot, and intravenous thrombolytic drugs given to break down these clots are an important part of the therapy to reduce the death rate from heart attack. These drugs do not remove occlusive, fatty atherosclerotic plaques within coronary vessels. Consequently, after thrombolytic therapy, MI patients with atherosclerosis are routinely monitored with angiography (which allows X-ray visualization of vessels) to determine if they require surgery to enhance their coronary circulation. Surgical procedures that improve coronary blood flow are coronary artery bypass surgery (CABS) and percutaneous transluminal coronary angioplasty (PTCA). It has not been determined whether follow-up angiography and surgery, as advocated for these patients, are always justified, or simply routine. It is thought that patients with atherosclerosis who have suffered a heart attack should only undergo CABS or PTCA if their angina (chest pain) is severe and when other noninvasive tests of ischemic (inadequate oxygen supply) risk deem them necessary. To explore whether there is an increased need for CABS or PTCA after thrombolytic therapy, seven clinical trials of the two thrombolytic agents approved in North America, tissue plasminogen activator and streptokinase, were evaluated. Results revealed an 80 percent increase in CABS and PTCA procedures among thrombolytic therapy patients within six weeks of their MI, compared with controls who received conventional post-MI therapy. This increase is suggested to represent a reasonable attempt to consolidate the immediate gains from lysing occlusive thrombi in infarct-related coronary arteries, rather than indicative of unnecessary medical intervention or a negative result of thrombolytic therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Physiological aspects, Drug therapy, Heart attack, Coronary artery bypass, Thrombosis, Fibrinolytic agents, Coronary arteries, Thrombolytic drugs, Angioplasty

---

Placing trials in context using Bayesian analysis: GUSTO revisited by Reverend Bayes

Article Abstract:

Bayesian analysis of clinical trials may provide more useful information than the more commonly used confidence intervals. Bayesian analysis is a statistical technique that allows researchers to take into account not only data but their prior beliefs. Though Bayesian analysis is sometimes criticized as being too complex, computer programs exist that can aid in the relevant computations. Additionally, the incorporation of the subjectivity of beliefs into the analysis allows researchers to update beliefs as more data become available. Researchers can then evaluate this effect on the data. As an example, the Global Utilization of Streptokinase and Tissue Plasminogen Activator in Occluded Arteries (GUSTO) trial is evaluated using Bayesian analysis. The results of the analysis suggest that the effectiveness of tissue plasminogen activator in the treatment of heart attacks remains to be proven.

Bayesian statistical decision theory, Bayesian analysis, Clinical trials

---

Evaluation of Decision Rules for Referring Women for Bone Densitometry by Dual-Energy X-ray Absorptiometry

Article Abstract:

The Simple Calculated Osteoporosis Risk Estimation (SCORE) and the Osteoporosis Risk Assessment Instrument (ORAI) can identify women at risk of osteoporosis who should have dual-energy x-ray absorptiometry testing. This test measures the density of bones but is too costly to use as a general screening tool on all women.

Diagnosis, Osteoporosis, Health status indicators, Decision support systems

Similar abstracts:

• Abstracts: Effect of antihypertensive therapy on the kidney in patients with diabetes: a meta-regression analysis. Trial of a drug to decrease the risk for heart disease in patients with mild kidney failure
• Abstracts: Blended Payment Methods in Physician Organizations Under Managed Care. The End of Managed Care
• Abstracts: Preventing infection from indwelling catheters. ANNOTATION: Supplement: Catheter-associated urinary tract infections: primary care guidelines
• Abstracts: High-risk patients with ventricular preexcitation -- a pendulum in motion. A molecular basis for Wolff-Parkinson-White syndrome
• Abstracts: Marriage of convenience. 'People compare me to Beverly Allitt.'. A head start in recovery

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.