Angioplasty is better than thrombolysis for acute myocardial infarct ▸

This review follows previous similar work on this subject published in this journal. It aimed to provide an updated quantitative analysis of the results of randomised trials of primary percutaneous transluminal coronary angioplasty (PTCA) compared with thrombolytic therapy for patients suffering from acute ST segment elevation myocardial infarction (AMI). The authors sought to identify all randomised trials comparing PTCA with thrombolysis, including unpublished data. They combined study results of 23 trials (involving 7739 patients) to calculate overall outcome measures including mortality, reinfarction, recurrent ischaemia, stroke, and major bleeding for each treatment group. Combined analysis showed that patients in the PTCA group had significantly lower morbidity and mortality rates than the thrombolysis group.

It seems ironic that thrombolysis may not be the “gold standard” for the treatment of AMI given the current quest for the UK National Service Framework 20 minute thrombolysis target. However, at present in the UK, emergency interventional cardiology is not widely available. The review specifically examined data from five trials in which transfer to another hospital for PTCA was compared with on-site thrombolysis. This continued to show significant decreases in morbidity such as non-fatal reinfarction, although there was not a significant decrease in mortality. None of the five trials were based in the UK, so further work may be needed to ascertain whether emergency PTCA should be the goal for patients with AMI in the UK.

Early corticosteroids do help acute asthma ▸

The stated objective of this review was to determine the effect of any form of systemic corticosteroids administered early in the course of treatment for patients presenting to the emergency department with acute asthma. The reviewers included all randomised, controlled trials in which patients …