VENTRICULAR ARRHYTHMIAS IN TRIALS OF THROMBOLYTIC THERAPY FOR ACUTE MYOCARDIAL-INFARCTION - A METAANALYSIS

Citation
Sd. Solomon et al., VENTRICULAR ARRHYTHMIAS IN TRIALS OF THROMBOLYTIC THERAPY FOR ACUTE MYOCARDIAL-INFARCTION - A METAANALYSIS, Circulation, 88(6), 1993, pp. 2575-2581
Citations number
49
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiac & Cardiovascular System",Hematology
Journal title
ISSN journal
0009-7322
Volume
88
Issue
6
Year of publication
1993
Pages
2575 - 2581
Database
ISI
SICI code
0009-7322(1993)88:6<2575:VAITOT>2.0.ZU;2-V
Abstract
Background. Although thrombolytic therapy reduces long-term mortality in acute myocardial infarction, many clinicians remain concerned about an increased risk of ventricular arrhythmias associated with the use of these agents. Methods and Results. To determine whether thrombolyti c therapy increases the risk of ventricular tachyarrhythmias and wheth er an increase in arrhythmias could be responsible for the increased m ortality seen in the first 24 hours after lytic therapy, we performed a meta-analysis of 15 randomized trials of thrombolysis in acute myoca rdial infarction in which the odds of developing in-hospital ventricul ar fibrillation (VF) and ventricular tachycardia (VT) in patients rece iving thrombolysis was compared with that of patients receiving placeb o. For trials that reported the incidence of VF during the first 6 hou rs after thrombolysis, the summary odds ratio for developing VP in the thrombolytic group was 0.98 (95% confidence interval [CI], 0.6 to 1.6 ; P=.94). For trials that reported the incidence of VP during the firs t hospital day, the summary odds ratio for developing VF was 1.00 (95% CI, 0.85 to 1.2; P=.95). The summary odds ratio for the development o f VF at any time during hospitalization in the thrombolytic group was 0.83 (95% CI, 0.76 to 0.90; P<.0001). In trials that reported the inci dence of VT any time during hospitalization, the summary odds ratio fo r the development of VT in the thrombolytic group was 1.34 (95% CI, 1. 15 to 1.55; P<.0001). Conclusions. The likelihood of developing VP in the early hours after thrombolysis for acute myocardial infarction is similar in patients receiving thrombolytics or placebo. However, throu ghout the hospital course, the risk of VP is greater in patients recei ving placebo, whereas the risk of VT is higher in patients receiving t hrombolysis.