Steven Borzak, MD; Paul M. Ridker, MD
Clinicians making treatment decisions are faced with ever-growing numbers of therapies, each supported by different types of clinical data. By bringing together large amounts of data, meta-analysis has emerged as a useful tool for generating hypotheses with which to plan definitive trials, and it has also been recommended as a basis for decision making in the absence of definitive trials. In several instances, early meta-analyses have provided evidence of efficacy that was subsequently confirmed. However, in other instances, the results of initial meta-analyses have disagreed with the results of subsequent large-scale trials.
Nitrate and magnesium therapy for acute myocardial infarction are two contemporary examples of treatments about which hypothesis-generating meta-analyses and subsequent large trials have disagreed. We review the issues surrounding the interpretation of meta-analyses in these cases, and we suggest that the appropriate use of meta-analyses in clinical decision making be carefully placed in the context of a review of pathophysiologic principles and the results of basic laboratory research and individual trials.
Borzak S, Ridker PM. Discordance between Meta-analyses and Large-Scale Randomized, Controlled Trials: Examples from the Management of Acute Myocardial Infarction. Ann Intern Med. ;123:873–877. doi: 10.7326/0003-4819-123-11-199512010-00010
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Published: Ann Intern Med. 1995;123(11):873-877.
Acute Coronary Syndromes, Cardiology, Coronary Heart Disease, Emergency Medicine.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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