From the FTT review (1):
Numbers needed to treat with thrombolysis (to save one life):
Anterior MI: 28
Inferior MI: 120
Numbers needed to harm with thrombolysis (to cause one death):
ST depression: 72 (the relation of this to posterior MI is unclear)
Normal ECG: 144
The 95% confidence intervals of the NNT in inferior MI overlap with those
for the NNH in normal ECGs. This is not the case for anterior MI, and the
difference is quite striking.
Therefore, the location of the MI should be taken into account (along with
age, co-morbidity, sex, warfarin use, recent surgery, bleeding risk, etc,
etc) when considering the risk/benefit ratio for each patient eligible for
thrombolysis.
Regards,
Jonathan Benger.
SpR, Bath.
(1) Fibrinolytic therapy trialists' (FTT) collaborative group. Indications
for fibrinolytic therapy in suspected acute myocardial infarction:
collaborative overview of early mortality and major morbidity results of all
randomised trials of more than 1000 patients. Lancet 1994;343:311-322.
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]]On Behalf Of Goat
Sent: 13 October 2002 20:59
To: [log in to unmask]
Subject: Re: Thrombolysis and previous surgery
I couldn't remember where I had heard this. Thanks for reminding me,
Rowley.
When I saw the original post, I went on the hunt for any guidelines on
the web differentiating between inferior and anterior MI for lysis - got
zip. Our Trust guidelines don't differentiate between MI sites for
lysis.
Is this one of those cases where the "evidence" has been over-sold?
Which of the many lysis trials can we get such info from? I coudl find
nothing on a quick title search on medline this pm.
Yes, you're right Rowley, I am just too lazy to look further myself, or
is it just too tired! Throw me a bone!
Goat
In article <[log in to unmask]>,
Rowley Cottingham <[log in to unmask]> writes
>Um, there is no evidence that thrombolysis affects the outcome in inferior
MIs,
>you know.
>
>Best wishes,
>
>
>Rowley Cottingham
>
>[log in to unmask]
>http://www.emergencyunit.com
Dr G Ray
A&E
Sussex
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