title: Comparison of primary percutaneous coronary intervention and fibrinolytic therapy in ST-segment-elevation myocardial infarction: bayesian hierarchical meta-analyses of randomized controlled trials and observational studies.
abstract: BACKGROUND
  Published meta-analyses comparing primary percutaneous coronary intervention with fibrinolytic therapy in patients with ST-segment-elevation myocardial infarction include only randomized controlled trials (RCTs). We aim to obviate the limited applicability of RCTs to real-world settings by undertaking meta-analyses of both RCTs and observational studies.
  
  
  RESULTS
  We included all RCTs and observational studies, without language restriction, published up to May 1, 2008. We completed separate bayesian hierarchical random-effect meta-analyses for 23 RCTs (8140 patients) and 32 observational studies (185 900 patients). Primary percutaneous coronary intervention was associated with reductions in short-term (< or =6-week) mortality of 34% (odds ratio, 0.66; 95% credible interval, 0.51 to 0.82) in randomized trials, and 23% lower mortality (odds ratio, 0.77; 95% credible interval, 0.62 to 0.95) in observational studies. Primary percutaneous coronary intervention was associated with reductions in stroke of 63% in RCTs and 61% in observational studies. At long-term follow-up (> or =1 year), primary percutaneous coronary intervention was associated with a 24% reduction in mortality (odds ratio, 0.76; 95% credible interval, 0.58 to 0.95) and a 51% reduction in reinfarction (odds ratio, 0.49; 95% credible interval, 0.32 to 0.66) in RCTs. However, there was no conclusive benefit of primary percutaneous coronary intervention in the long term in the observational studies.
  
  
  CONCLUSIONS
  Compared with fibrinolytic therapy, primary percutaneous coronary intervention was associated with short-term reductions in mortality, reinfarction, and stroke in ST-segment-elevation myocardial infarction. Primary percutaneous coronary intervention was associated with long-term reductions in mortality and reinfarction in RCTs, but there was no conclusive evidence for a long-term benefit in mortality and reinfarction in observational studies.
authors.affiliation: 1650 Ave Cedar, Room E-5200, Montreal, Quebec, H3G-1A4, Canada. thao.huynhthanh@mail.mcgill.ca
authors.forename: Thao
authors.initials: T
authors.lastname: Huynh
authors.forename: Stephane
authors.initials: S
authors.lastname: Perron
authors.forename: Jennifer
authors.initials: J
authors.lastname: O'Loughlin
authors.forename: Lawrence
authors.initials: L
authors.lastname: Joseph
authors.forename: Michel
authors.initials: M
authors.lastname: Labrecque
authors.forename: Jack V
authors.initials: JV
authors.lastname: Tu
authors.forename: Pierre
authors.initials: P
authors.lastname: Théroux
mesh_terms: D006328:Cardiac Catheterization; D005260:Female; D005342:Fibrinolysis; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D011237:Predictive Value of Tests; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000209:etiology; D015912:Thrombolytic Therapy; D013997:Time Factors