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Systematic review and meta-analysis

This trial is included in the following systematic reviews and meta-analyses:

acute myocardial infarction - myocardial revascularization - all type of patients

acute myocardial infarction - PCI - all type of patients


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senior PAMI, 2005 - primary PCI vs Thrombolysis

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Di Lorenzo et al., 2005 - sirolimus eluting stent vs paclitaxel eluting stent

GRACIA-1, 2004 - systematic PCI (+stent) vs no systematic PCI

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See also:

  • All acute myocardial infarction clinical trials
  • All clinical trials of PCI
  • All clinical trials of systematic PCI (+stent)
    		•  

    GRACIA-1 study, 2004

    Facebook    pdf : systematic PCI (+stent) - myocardial revascularization for acute myocardial infarction

    Treatments

    Studied treatment angiography and intervention if indicated within 24 h of thrombolysis
    Control treatment ischaemia-guided conservative approach
    Treatments description
    stent (%) 80% 
    time from thrombolysisi to PCI in invasive arm 17.6 h 

    Patients

    Patients patients with thrombolysed STEMI (with recombinant tissue plasminogen activator)
    Baseline characteristics
    Age (year) 60 y 
    female (%) 14% 

    Method and design

    Randomized effectives 248 / 251 (studied vs. control)
    Design Parallel groups
    Follow-up duration 12 months
    Primary endpoint death, reinfarction, or revascularisation


    Results

    Endpoint Studied treat.
    n/N     Control treat.
    n/N     Graph RR [95% CI]

    In-hospital death

    9 / 248
         16 / 251
         0,57 [0,26;1,26]

    reinfarction

    9 / 248
         15 / 251
         0,61 [0,27;1,36]

    Major bleeding

    4 / 248
         2 / 251
         classic 2,02 [0,37;10,95]

    stroke (fatal and non fatal)

    0 / 248
         1 / 251
         classic 0,20 [0,00;14,78]     0 2 1.0

    Relative risks
    Endpoint Events (%) Relative Risk 95% CI Endpoint definition
    in the trial    		 Ref
    Studied treat. Control treat.
    In-hospital death 9 / 248 (3,6%) 16 / 251 (6,4%) 0,57 [0,26;1,26]   9448 
    reinfarction 9 / 248 (3,6%) 15 / 251 (6,0%) 0,61 [0,27;1,36]   9448 
    Major bleeding 4 / 248 (1,6%) 2 / 251 (0,8%) 2,02 [0,37;10,95]   9448 
    stroke (fatal and non fatal) 0 / 248 (0,2%) 1 / 251 (0,4%) 0,51 [0,02;15,02]   9448 
    The primary endpoint (if exists) appears in blod characters
    Reference(s) used for data extraction:
  • 9448: Wijeysundera HC, You JJ, Nallamothu BK, Krumholz HM, Cantor WJ, Ko DTAn early invasive strategy versus ischemia-guided management after fibrinolytic therapy for ST-segment elevation myocardial infarction: a meta-analysis of contemporary randomized controlled trials.Am Heart J 2008;156:564-572, 572.e1-2

    • Endpoint studied treat. control treat. mean diff

    Absolute risk reduction
    Endpoint Events rate Absolute risk
    reduction (ARR)
    Studied treat. Control treat.
    In-hospital death 3,63% 6,37% -27,5‰
    reinfarction 3,63% 5,98% -23,5‰
    Major bleeding 1,61% 7,97‰ 8,2‰

    Meta-analysis of all similar trials:

    myocardial revascularization in acute myocardial infarction for all type of patients

    PCI in acute myocardial infarction for all type of patients



    Reference(s)

    Trials register # NA
    • Fernandez-Avil�s F, Alonso JJ, Castro-Beiras A, V�zquez N, Blanco J, Alonso-Briales J, L�pez-Mesa J, Fern�ndez-Vazquez F, Calvo I, Mart�nez-Elbal L, San Rom�n JA, Ramos B. Routine invasive strategy within 24 hours of thrombolysis versus ischaemia-guided conservative approach for acute myocardial infarction with ST-segment elevation (GRACIA-1): a randomised controlled trial.. Lancet 2004;364:1045-53
      Pubmed | Hubmed | Fulltext

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