Myocardial infarction (ST-elevation)
1Emergency Care Research Unit (ECRU), Midland Regional Hospital, Tullamore, Ireland.
Insights
This systematic review analyzes treatments for acute myocardial infarction (MI) and cardiogenic shock. It found various interventions, including ACE inhibitors and thrombolysis, that impact patient outcomes.
Area of Science:
- Cardiology
- Clinical Medicine
- Evidence-Based Medicine
Background:
- Acute myocardial infarction (MI) has a high mortality rate, with a significant portion of deaths occurring within the first hour.
- Cardiogenic shock post-MI affects over 5% of survivors, carrying a 50-80% mortality within 48 hours.
Purpose of the Study:
- To systematically review treatments that improve outcomes in acute myocardial infarction (MI).
- To identify treatments that enhance outcomes for patients experiencing cardiogenic shock after MI.
Main Methods:
- Conducted a systematic review of medical literature up to October 2009.
- Searched major databases including Medline, Embase, and The Cochrane Library.
- Included safety alerts from regulatory agencies like the FDA and MHRA.
Main Results:
- Included 52 systematic reviews, randomized controlled trials (RCTs), and observational studies.
- Performed a GRADE evaluation to assess the quality of evidence for interventions.
Conclusions:
- Evaluated the effectiveness and safety of numerous interventions for acute MI and cardiogenic shock.
- Interventions reviewed include ACE inhibitors, aspirin, beta-blockers, thrombolysis, and primary percutaneous transluminal coronary angioplasty (PTCA).
Introduction:
About one quarter of people having an acute myocardial infarction (MI) in the USA will die of it, half of them within 1 hour of the onset of symptoms. Cardiogenic shock develops in over 5% of people surviving the first hour after an acute MI, with a mortality of 50% to 80% in the first 48 hours.
Methods And Outcomes:
We conducted a systematic review and aimed to answer the following clinical questions: Which treatments improve outcomes in acute MI? Which treatments improve outcomes for cardiogenic shock after MI? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
Results:
We found 52 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
Conclusions:
In this systematic review we present information relating to the effectiveness and safety of the following interventions: angiotensin-converting enzyme (ACE) inhibitors, aspirin, beta-blockers, calcium channel blockers, early cardiac surgery, early invasive cardiac revascularisation, glycoprotein IIb/IIIa inhibitors, intra-aortic balloon counterpulsation, nitrates (with or without thrombolysis), positive inotropes, primary percutaneous transluminal coronary angioplasty (PTCA), pulmonary artery catheterisation, thrombolysis (with or without low molecular weight heparin, with or without unfractionated heparin), vasodilators, and ventricular assistance devices and cardiac transplantation.
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