Primary coronary angioplasty compared with intravenous thrombolytic therapy for acute myocardial infarction: six-month follow up and analysis of individual patient data from randomized trials PCAT Collaborators CRD summary This review of individual patient data compared primary coronary angioplasty (PTCA) with thrombolysis for acute myocardial infarction. Primary PTCA was more effective than thrombolytic therapy in reducing death, reinfarction, and stroke, with greatest absolute benefits for high risk patients. The conclusions are reliable, but treatment effects varied across the trials raising issues about how widely the results can be applied Authors' objectives To compare the effectiveness of primary percutaneous transluminal coronary angioplasty (PTCA) and thrombolysis in acute myocardial infarction (MI) during a 6-month follow-up period. Searching Trials were identified through a computerised bibliographic search of MEDLINE from January 1985 to January 1998. Abstracts of scientific sessions in Circulation, the Journal of the American College of Cardiology, and the European Heart Journal were searched from January 1993 to January 1998. Experts in the field were contacted for any additional published or unpublished studies. A steering committee and a writing committee (PCAT collaborators) was established to identify trials and undertake the meta-analysis. Study selection Study designs of evaluations included in the review The review included individual patient data (IPD) from randomised controlled trials (RCTs). Specific interventions included in the review Comparisons of primary PTCA with intravenous thrombolytic drug therapy. The specific thrombolytic drug therapies were streptokinase, 3- and 4-hour tissue type plasminogen activator (tPA), 90-minute accelerated tPA and duteplase. Participants included in the review People with suspected acute MI with an ST elevation of at least 1 mm in two contiguous leads or a left bundle branch block, no major contraindications to the use of thrombolytic drug therapy, and who had been randomised within 6 hours of suspected acute coronary occlusion, were eligible. Male and female participants were included; the median ages were 61 and 62 years, respectively. The co-morbidities recorded were diabetes, previous MI and prior PTCA or coronary artery bypass graft (CABG). Outcomes assessed in the review The outcomes assessed were the rates of total mortality, reinfarction, death or nonfatal reinfarction, total stroke, haemorrhagic stroke, major bleeding (requiring transfusion) and CABG. How were decisions on the relevance of primary studies made? The relevance of the primary studies was established through communication with trial investigators. Assessment of study quality The authors reviewed each trial to assess the validity of randomisation of treatment allocation, exclusions from Database of Abstracts of Reviews of Effects (DARE) Produced by the Centre for Reviews and Dissemination Copyright © 2017 University of York Page: 1 / 4