Showing papers by "Elliott M. Antman published in 1992"
TL;DR: Finding and analyzing all therapeutic trials in a given field has become such a difficult and specialized task that the clinical experts called on to summarize the evidence in a timely fashion need access to better databases and new statistical techniques to assist them.
Abstract: Objective —To examine the temporal relationship between accumulating data from randomized control trials of treatments for myocardial infarction and the recommendations of clinical experts writing review articles and textbook chapters Data Sources —(1) MEDLINE search from 1966 to present; search terms used were myocardial infarction, clinical trials, multicenter studies, double-blind method, meta-analysis , and the text word "random:"; (2) references from pertinent articles and books; and (3) all editions of English-language general medical texts and manuals and review articles on treatment of myocardial infarction Study Selection —Randomized control trials of therapies for reducing the risk of total mortality in myocardial infarction (acute and secondary prevention) Review articles and textbook chapters dealing with the general clinical management of patients with myocardial infarction Data Extraction —Two authors read the material and recorded the results; disagreements were resolved by conference Data Synthesis —We used the technique of cumulative meta-analysis (performing a new meta-analysis when the results of a new clinical trial are published) and compared the results with the recommendations of the experts for various treatments for myocardial infarction Discrepancies were detected between the meta-analytic patterns of effectiveness in the randomized trials and the recommendations of reviewers Review articles often failed to mention important advances or exhibited delays in recommending effective preventive measures In some cases, treatments that have no effect on mortality or are potentially harmful continued to be recommended by several clinical experts Conclusions —Finding and analyzing all therapeutic trials in a given field has become such a difficult and specialized task that the clinical experts called on to summarize the evidence in a timely fashion need access to better databases and new statistical techniques to assist them in this important task ( JAMA 1992;268:240-248)
1,405 citations
TL;DR: Cumulative meta-analysis of therapeutic trials facilitates the determination of clinical efficacy and harm and may be helpful in tracking trials, planning future trials, and making clinical recommendations for therapy.
Abstract: Background. The large volume of published randomized, controlled trials has led to a need for meta-analyses to track therapeutic advances. Performing a new meta-analysis whenever the results of a new trial of a particular therapy are published permits the study of trends in efficacy and makes it possible to determine when a new treatment appears to be significantly effective or deleterious. We describe the use of such a procedure, cumulative meta-analysis, to assess therapeutic trials among patients with myocardial infarction. Methods. We performed cumulative meta-analyses of clinical trials that evaluated 15 treatments and preventive measures for acute myocardial infarction. Results. An example of this method is its application to the use of intravenous streptokinase as thrombolytic therapy for acute infarction. Thirty-three trials evaluating this therapy were performed between 1959 and 1988. We found that a consistent, statistically significant reduction in total mortality (odds ratio, 0.74; 95...
1,088 citations
TL;DR: Present estimates of the risk: benefit ratio of lidocaine prophylaxis should consider the low risk of VF in control patients and the large number who need lidocane prophYLaxis to prevent one episode of V fibrillation.
Abstract: BACKGROUNDThe purposes of the present investigation were 1) to track the incidence of primary ventricular fibrillation (VF) in the control and lidocaine-treated groups in the randomized control trials (RCTs) of lidocaine prophylaxis against primary VF in acute myocardial infarction, with particular emphasis on the time frame of the randomized trial, and 2) to estimate the number of patients who must receive lidocaine currently to prevent one episode of VF.METHODS AND RESULTSThe following variables from RCTs published between 1969 and 1988 were entered into logistic regression models to predict the percent of patients developing VF: year of publication of the RCT, method of data analysis used in the RCT, route and technique of lidocaine administration, duration of monitoring for VF, and exclusion criteria before randomization (congestive heart failure/cardiogenic shock, ventricular tachycardia/VF, or bradycardia/atrioventricular block). Year of publication was a significant predictor of VF in both the cont...
93 citations
TL;DR: In this article, a meta-analysis of data from 20 years of randomized trials of lidocaine prophylaxis in preventing primary ventricular fibrillation (VF) in myocardial infarction used separate data for control and active-treatment groups.
65 citations
TL;DR: Compared to findings in the randomized control trials, the magnitude of the treatment benefit in nonrandomized trials was smaller and declined markedly over time, and the percentage of patients remaining in sinus rhythm in the uncontrolled trials was intermediate to the percentages in the other two trial designs.
44 citations