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Discordance between Meta-analyses and Large-Scale Randomized, Controlled Trials: Examples from the Management of Acute Myocardial Infarction
- Steven Borzak, MD; and
- Paul M. Ridker, MD
- From Henry Ford Hospital, Detroit, Michigan; and Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Acknowledgments: The authors thank Lori Douthat for assistance in figure and manuscript preparation and Dr. Elliott Antman for reviewing the manuscript. Grant Support: Dr. Ridker is a Clinician Scientist of the American Heart Association. Requests for Reprints: Steven Borzak, MD, Cardiovascular Division, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI, 48202. Current Author Addresses: Dr. Borzak: Cardiovascular Division, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI, 48202.
Abstract
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.
- Copyright ©2004 by the American College of Physicians
