
Thrombolytics Given for Major Heart Attack (STEMI)

Benefits in NNT
43
1 in 43 were helped (life saved, given within 6 hours)
63
1 in 63 were helped (life saved, given between 6-12 hours)
200
1 in 200 were helped (life saved, given between 12-24 hours)

Harms in NNT
143
1 in 143 were harmed (major bleeding episode)
250
1 in 250 were harmed (hemorrhagic stroke)
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Efficacy Endpoints
Death at 1 month following acute heart attack (STEMI)Harm Endpoints
Major bleeding (brain bleeding or bleeding requiring transfusion).Narrative
This systematic review includes 9 trials and 58600 patients randomized to receive a fibrinolytic drug or placebo for suspected heart attack. Patients were enrolled based on strong suspicion of heart attack by the treating doctor. Most (76%) were men, and most had ST-elevations on their EKG (68%). There was an overall mortality benefit of 1.9% (9.6 vs. 11.5) in favor of fibrinolytics. There was also a 0.4% increase in hemorrhagic stroke (1.2 vs. 0.8). Benefit was demonstrably greater with earlier treatment, with the most benefit apparent for treatment given within a few hours of symptom onset. Benefits were smaller and less statistically robust in the 12 to 24 hour period. Patients with ST-depressions were harmed rather than helped.Caveats
There was no gold standard to prove STEMI (e.g. catheterization or biomarkers) and some patients had normal EKG’s (5%). There is heterogeneity between trials, including inconsistency in the use of aspirin. However, groups appear to have been randomized well and treated equally with respect to other interventions.Author
Joshua Quaas, MDPublished/Updated
January 19, 2010