Misleading meta-analysis
BMJPublished 25 March 1995Open access
Matthias Egger, George Davey Smith
Citations506
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TL;DR
A meta-analysis of treatments in myocardial infarction published in 1992 retrospectively showed that streptokinase was associated with a highly significant fall in mortality by 1977, but it was not widely recommended until 10 years later—after the effect was confirmed in two mega trials.
Keywords
Decision SciencesMedicine
Progress in Cardiovascular DiseasesBeta blockade during and after myocardial infarction: An overview of the randomized trials
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58,050 patients entering hospitals up to 24 h after the onset of suspected acute myocardial infarction with no clear contraindications to the study treatments were randomised in a "2 x 2 x 2 factorial" study, reassuring a bout the safety of using nitrates early in acute MI.
JAMAA Comparison of Results of Meta-analyses of Randomized Control Trials and Recommendations of Clinical Experts
1,464 Citations1992Elliott M. Antman
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.
BMJMisleading meta-analysis
506 Citations1995Matthias Egger, George Davey Smith
A meta-analysis of treatments in myocardial infarction published in 1992 retrospectively showed that streptokinase was associated with a highly significant fall in mortality by 1977, but it was not widely recommended until 10 years later—after the effect was confirmed in two mega trials.
The LancetEFFECT OF INTRAVENOUS NITRATES ON MORTALITY IN ACUTE MYOCARDIAL INFARCTION: AN OVERVIEW OF THE RANDOMISED TRIALS
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The greatest reduction in mortality occurred during the first week or so of follow-up, with a non-significant further reduction after this early period, suggesting that the early benefit is not rapidly lost.
BMJGetting to grips with Archie Cochrane's agenda.
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The results quantify a trigger leading to rapid, drought-induced die-off of overstory woody plants at subcontinental scale and highlight the potential for such die-offs to be more severe and extensive for future global-change-type drought under warmer conditions.
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The American Journal of CardiologyMagnesium therapy in acute myocardial infarction when patients are not candidates for thrombolytic therapy
102 Citations1995Michael Shechter, Hanoch Hod +3 more
In-hospital mortality was significantly reduced in patients receiving magnesium sulfate than in those receiving placebo, and also in the subgroup of elderly patients (> 70 years) (9% vs 23%; p = 0.09), and magnesium sulfates should be considered as an alternative therapy to thrombolysis in patients with AMI.
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80 Citations1995Salim Yusuf, Marcus Flather
An informal review of the results of the early clinical trials in acute myocardial infarction indicated a trend towards a lower mortality with intravenous magnesium, with this difference being statistically significant in only one trial.
International Journal of CardiologyEffects of magnesium infusion on thrombolytic and non-thrombolytic treated patients with acute myocardial infarction
20 Citations1993Anna Margrethe Thøgersen, Owe Johnson +1 more
It is indicated that magnesium infusion may have a beneficial effect on mortality in patients with acute myocardial infarction not receiving thrombolytic therapy, but opposes the view that the benefit is related to an antiarrhythmic effect.
International Journal of CardiologyEffects of intravenous magnesium sulphate in suspected acute myocardial infarction on acute arrhythmias and long-term outcome
20 Citations1995Anna Margrethe Thøgersen, Owe Johnson +1 more
The results of this study supports the results of other small double blind placebo controlled studies regarding effects of magnesium therapy on mortality in acute myocardial infarction, but are in discordance to the conclusion from the ISIS-4 study.
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Meta‐analyses should be viewed as a powerful addition to traditional methods of reviewing medical evidence, however, care should be taken not to go beyond the available data in interpreting their results.
PubMed[Effect of intravenous administration of SO4Mg in the acute phase of myocardial infarct].
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It is suggested that magnesium sulphate administration reduces the incidence of arrhythmias and death after acute myocardial infarction.