Asunto(s)
Apocynaceae , Odorantes , Publicaciones Periódicas como Asunto , Relajación , Olfato , Actitud hacia los Computadores , Políticas Editoriales , Hawaii , HumanosRESUMEN
AIMS: To perform a thorough and updated systematic review of randomized clinical trials comparing tirofiban vs. placebo or vs. abciximab. METHODS AND RESULTS: We searched for randomized trials comparing tirofiban vs. placebo or any active control. Odds ratios (OR) were computed from individual studies and pooled with random-effect methods. Thirty-one studies were identified involving 20,006 patients (12 874 comparing tirofiban vs. heparin plus placebo or bivalirudin alone, and 7132 vs. abciximab). When compared with placebo, tirofiban was associated at 30 days with a significant reduction in mortality [OR = 0.68 (0.54-0.86); P = 0.001] and death or myocardial infarction (MI) [OR = 0.69 (0.58-0.81); P < 0.001]. The treatment benefit persisted at follow-up but came at an increased risk of minor bleedings [OR = 1.42 (1.13, 1.79), P = 0.002] or thrombocytopenia. When compared with abciximab, mortality at 30 days did not differ [OR = 0.90 (0.53, 1.54); P = 0.70], but in the overall group tirofiban trended to increase the composite of death or MI [OR = 1.18 (0.96, 1.45); P = 0.11]. No such trend persisted at medium-term follow-up or when appraising studies testing tirofiban at 25 microg/kg bolus regimen. CONCLUSION: Tirofiban administration reduces mortality, the composite of death or MI and increases minor bleedings when compared with placebo. An early ischaemic hazard disfavouring tirofiban was noted when compared with abciximab in studies based on 10 but not 25 microg/kg tirofiban bolus regimen.
Asunto(s)
Síndrome Coronario Agudo/terapia , Angioplastia Coronaria con Balón/métodos , Inhibidores de Agregación Plaquetaria/uso terapéutico , Tirosina/análogos & derivados , Abciximab , Síndrome Coronario Agudo/mortalidad , Anticuerpos Monoclonales/uso terapéutico , Anticoagulantes/uso terapéutico , Quimioterapia Adyuvante , Hemorragia/inducido químicamente , Hirudinas , Humanos , Fragmentos Fab de Inmunoglobulinas/uso terapéutico , Fragmentos de Péptidos/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto , Proteínas Recombinantes/uso terapéutico , Análisis de Regresión , Tirofibán , Tirosina/uso terapéuticoRESUMEN
OBJECTIVES: The aim of this study was to evaluate the rate of timely reperfusion for ST-elevation myocardial infarction (STEMI) with primary percutaneous coronary intervention (PPCI) in regional STEMI Receiving Center (SRC) networks. BACKGROUND: The American College of Cardiology Door-to-Balloon (D2B) Alliance target is a >75% rate of D2B Asunto(s)
Angioplastia Coronaria con Balón
, Prestación Integrada de Atención de Salud
, Electrocardiografía
, Servicios Médicos de Urgencia
, Accesibilidad a los Servicios de Salud
, Infarto del Miocardio/diagnóstico
, Infarto del Miocardio/terapia
, Programas Médicos Regionales
, Ambulancias
, Prestación Integrada de Atención de Salud/organización & administración
, Servicios Médicos de Urgencia/organización & administración
, Adhesión a Directriz
, Accesibilidad a los Servicios de Salud/organización & administración
, Humanos
, Objetivos Organizacionales
, Guías de Práctica Clínica como Asunto
, Estudios Prospectivos
, Programas Médicos Regionales/organización & administración
, Sistema de Registros
, Factores de Tiempo
, Triaje
, Estados Unidos