In the eighth article of the SOCRATES series we present our synopses of reviews from the Cochrane Database of Systematic Reviews relating to cardiology and infection that the working party felt were of particular relevance to emergency medicine practitioners. The methods of our review and the rationale for forming the SOCRATES working party are as have previously been published.

CARDIOLOGY: PRIMARY ANGIOPLASTY VERSUS INTRAVENOUS THROMBOLYSIS FOR ACUTE MYOCARDIAL INFARCTION

Intravenous thrombolysis therapy is the standard care for management of myocardial infarction. However, certain patients may be ineligible for treatment with thrombolytics, and, of those given thrombolytic therapy, 10–15% have persistent occlusion or reocclusion of the infarct related artery. Consequently, primary angioplasty (primary percutaneous transluminal coronary angioplasty (PTCA)) has been advocated as a better treatment for myocardial infarction.

Results

Ten trials including 2573 subjects were identified. Compared with thrombolytic therapy, primary angioplasty was associated with the following:

• significant reduction in short-term mortality at the end of the studies (relative risk reduction (RRR) 32%; 95% CI 5% to 50%)

• significant reduction of the rates of reinfarction (RRR 52%; 95% CI 30% to 67%)

• significant reduction in the rates of recurrent ischaemia (RRR 54%; 95% CI 39% to 66%)

• significant reduction also of frequency of strokes by 66% (95% CI 28% to 84%)

• superiority of primary angioplasty over thrombolysis in terms of the composite endpoint (mortality and reinfarction) was less with accelerated tissue plasminogen activator (tPA) (RR 0.70; 95% CI …