Lyse and Statistics: GRACIA-2 vs. ASSENT-4

The first Journal Club of the year got off to a thunderous start (there was lightning and flooding, too, and an explosion a little bit later). Those who braved the elements participated in a discussion about thrombolysis before angioplasty for STEMI, centered on two papers with two different conclusions about its benefit.

The primary paper we covered was from the GRACIA-2 non-inferiority RCT, called Primary angioplasty vs. early routine post-fibrinolysis angioplasty for acute myocardial infarction with ST-segment elevation (from the European Heart Journal 2007 Vol. 28, p949-960).

Our secondary paper was from the ASSENT-4 RCT, called Primary verses tenecteplase-facilitated percutaneous coronary intervention in patients with ST-segment elevation acute MI (from the Lancet 2006: Vol 367, p569-578).

MSCT for ACS: Good in Stressful Situations?

For the final journal club of the year, Ravi picked an article from Goldstein (and others)  entitled, “A Randomized Controlled Trial of Multi-Sliced Coronary Computed Tomography for Evaluation of Acute Chest Pain” (available from the Journal of the American College of Cardiology, 2007 Vol 49, No. 8, pp863-871).

It’s not the definitive, practice-changing study we’re waiting for, but it draws upon previous work (such as JAMA 2005; 293:2471-8) estabilishing multi-slice CT coronary angiography as effective in diagnosing occlusion, and attempts to compare the safety, efficacy and efficiency of MSCT against established protocols.

tPA with CPR: a meta-analysis

This month’s journal club presentation began with what I believe was a discussion of blood clots in Cro-Mags before touching upon late 19th century versions of CPR, the landmark closed-chest cardiac massage paper, and eventually, a comparison of ROSC (return of spontaneous circulation) in real patients vs. as seen on television. Chad then led the group in a discussion of a new meta-analysis by Xin Li et al appearing in a recent issue of Resuscitation (2006: Vol 70, pp31-36) on the topic of CPR with and without thrombolytics.