Difference between revisions of "Dekleva"

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==Hyperbaric oxygen with thrombolysis in myocardial infarction: positive effect on cardiac echo indices==
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'''<span style="font-size:18.0pt"><span style="line-height:107%"><span style="font-family:" arial",sans-serif"="">Hyperbaric oxygen with thrombolysis in myocardial infarction: positive effect on cardiac echo indices</span></span></span>'''
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| '''1. Hyperbaric oxygen with thrombolysis produced improvements in left ventricular function'''<br>**2. The clinical significance of this is unclear.'''  
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'''<span style="font-size:14.0pt"><span style="line-height:107%"><span style="font-family:" arial",sans-serif"="">Clinical Bottom Line:</span></span></span>'''
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{| class="Table" style="background:white; border-collapse:collapse; border:solid windowtext 1.0pt"
 
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<span style="line-height:normal"><span style="font-size:14.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">1. Hyperbaric oxygen with thrombolysis produced improvements in left ventricular function</span></span></span><br/> <span style="font-size:14.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">2. The clinical significance is unclear</span></span></span></span>
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**Citation/s:'''
 
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 90%;">1. Dekleva MN, Ostojic M, Vujnovic D. Hyperbaric oxygen and thrombolysis in acute myocardial infarction: a preliminary report. In: Sitinen SA, Leinio M, eds. Proceedings of the Twenty-first Annual Meeting of the European Underwater and Baromedical Society (EUBS), Helsinki, Finland 1995:9-13</span>
 
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2. Dekleva M, Neskovic A, Vlahovic A et al. Adjunctive effect of hyperbaric oxygen treatment after thrombolysis on left ventricular function in patients with acute myocardial infarction. Am Heart J 2004; 148(4):589
 
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**Lead author's name and fax:''' Milica Dekleva
 
  
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**Three-part Clinical Question:''' In patients suffering acute myocardial infarction, does the addition of hyperbaric oxygen therapy improve echocardiography / angiography results, when compared to standard therapy including a thrombolytic.
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<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Citation/s:</span></span></span>'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">1. Dekleva MN, Ostojic M, Vujnovic D. Hyperbaric oxygen and thrombolysis in acute myocardial infarction: a preliminary report. In: Sitinen SA, Leinio M, eds. Proceedings of the Twenty-first Annual Meeting of the European Underwater and Baromedical Society (EUBS), Helsinki, Finland 1995:9-13 2. Dekleva M, Neskovic A, Vlahovic A et al. Adjunctive effect of hyperbaric oxygen treatment after thrombolysis on left ventricular function in patients with acute myocardial infarction. Am Heart J 2004; 148(4):589.</span></span></span></span></span>
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**Search Terms:''' Myocardial infarction, echocardiography; thrombolytic therapy
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<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Lead author's name and fax:</span></span></span>'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Milica Dekleva</span></span></span></span></span>
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<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Three-part Clinical Question:</span></span></span>'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">In patients suffering acute myocardial infarction, does the addition of hyperbaric oxygen therapy improve echocardiography / angiography results, when compared to standard therapy including a thrombolytic.</span></span></span></span></span>
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<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Search Terms:</span></span></span>'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Myocardial infarction, echocardiography; thrombolytic therapy</span></span></span></span></span>
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<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">The Study:</span></span></span>'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Single-blinded (outcome observer) randomised controlled trial without intention-to-treat.</span></span></span></span></span>
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<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">The Study Patients:</span></span></span>'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133"><70 years old, chest pain unrelieved by anginine, ST-segment elevation, transient CK and/or MB isoenzyme rises, 1st echo within 24 hours of pain onset. Exclusions: previous MI, bypass surgery, unstable (arrhythmia, etc), heart failure, as well as standard thrombolytic and HBOT contraindications.</span></span></span></span></span>
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<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Control group</span></span></span>'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">(N = 37; 37 analysed): Streptokinase (1.5mU/L), followed by heparin.</span></span></span></span></span>
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<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Experimental group</span></span></span>'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">(N = 37; 37 analysed): As above, followed by HBOT: one treatment - 2.0 ATA for 60 minutes.</span></span></span></span></span>
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<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">The Evidence:</span></span></span>'''</span></span>
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&nbsp;
  
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**The Study:'''Single-blinded (outcome observer) randomised controlled trial without intention-to-treat.
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{| class="Table" style="width:460.45pt; background:white; border-collapse:collapse; border:solid windowtext 1.0pt" width="0"
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**The Study Patients:''' <70 years old, chest pain unrelieved by anginine, ST-segment elevation, transient CK and/or MB isoenzyme rises, 1st echo within 24 hours of pain onset. Exclusions: previous MI, bypass surgery, unstable (arrhythmia, etc), heart failure, as well as standard thrombolytic and HBOT contraindications.
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**Control group''' (N = 37; 37 analysed): Streptokinase (1.5mU/L), followed by heparin.
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| style="width:77.75pt; border:solid windowtext 1.0pt; background:white" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal">'''<span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">Outcome</span></span></span>'''</span></p>
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**Experimental group''' (N = 37; 37 analysed): As above, followed by HBOT: one treatment - 2.0 ATA for 60 minutes.
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| style="width:2.0cm; border:solid windowtext 1.0pt; border-left:none; background:white" width="76" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal">'''<span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">Time to Outcome</span></span></span>'''</span></p>
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| style="width:49.6pt; border:solid windowtext 1.0pt; border-left:none; background:white" width="66" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal">'''<span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">Control group</span></span></span>'''</span></p>
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| style="width:42.5pt; border:solid windowtext 1.0pt; border-left:none; background:white" width="57" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal">'''<span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">HBO group</span></span></span>'''</span></p>
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| style="width:70.9pt; border:solid windowtext 1.0pt; border-left:none; background:white" width="95" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal">'''<span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">Relative risk reduction</span></span></span>'''</span></p>
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| style="width:77.95pt; border:solid windowtext 1.0pt; border-left:none; background:white" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal">'''<span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">Absolute risk reduction</span></span></span>'''</span></p>
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| style="width:3.0cm; border:solid windowtext 1.0pt; border-left:none; background:white" width="113" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal">'''<span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">NNT</span></span></span>'''</span></p>
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| style="width:77.75pt; border:solid windowtext 1.0pt; border-top:none; background:white" width="104" |
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<span style="line-height:normal">'''<span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">Cardiac Mortality</span></span></span>'''</span>
  
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**The Evidence:'''
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| style="width:2.0cm; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="76" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">3 weeks?</span></span></span></span></p>
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{|
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| style="width:49.6pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="66" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">0.027</span></span></span></span></p>
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| <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''Event'''</span></span><span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''Outcome''' </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''Time to Outcome''' </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''Control group''' </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''HBO group''' </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''Relative risk reduction'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''Absolute risk reduction'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''NNT''' </span></span>  
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| style="width:42.5pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="57" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">0</span></span></span></span></p>
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| style="width:70.9pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="95" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">100%</span></span></span></span></p>
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| style="width:77.95pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">0.027</span></span></span></span></p>
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| style="width:3.0cm; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="113" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">37</span></span></span></span></p>  
 
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| <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">Cardiac Mortality </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">3 weeks?</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">0.027</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">0</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">100%</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">0.027</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">37</span></span>  
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| style="width:77.75pt; border:solid windowtext 1.0pt; border-top:none; padding:0cm 0cm 0cm 0cm; background:white" width="104" | &nbsp;
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| style="width:2.0cm; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; padding:0cm 0cm 0cm 0cm; background:white" width="76" | &nbsp;
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| style="width:49.6pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; padding:0cm 0cm 0cm 0cm; background:white" width="66" | &nbsp;
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| style="width:42.5pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="57" | <p align="right" style="margin-bottom:.0001pt; text-align:right; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">95% CI:</span></span></span></span></p>
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| style="width:70.9pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; padding:0cm 0cm 0cm 0cm; background:white" width="95" | &nbsp;
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| style="width:77.95pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">-0.03 to 0.08</span></span></span></span></p>
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| style="width:3.0cm; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="113" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">NNT 13 to INF</span></span></span></span></p>
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<span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">&nbsp;NNH</span></span></span><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">40 to INF</span></span></span></span>
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|^  |||||| <span style'''"display: block; text-align: right;"><span style'''"display: block; text-align: right;">95% Confidence Intervals:</span></span> ||  || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">-0.03 to 0.08</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">NNT ''' 13 to INF</span></span><span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">NNH ''' 40 to INF</span></span>  
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| style="width:77.75pt; border:solid windowtext 1.0pt; border-top:none; background:white" width="104" |  
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<span style="line-height:normal">'''<span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">Angiography - collaterals</span></span></span>'''</span>
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| style="width:2.0cm; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="76" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">3 weeks?</span></span></span></span></p>
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| style="width:49.6pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="66" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">0.243</span></span></span></span></p>
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| style="width:42.5pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="57" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">0.243</span></span></span></span></p>
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| style="width:70.9pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="95" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">5%</span></span></span></span></p>
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| style="width:77.95pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">0.027</span></span></span></span></p>
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| style="width:3.0cm; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="113" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">37</span></span></span></span></p>  
 
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| <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">Angiography - collaterals</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">3 weeks?</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">0.243</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">0.243</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">5%</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">0.027</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">37</span></span>  
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| style="width:77.75pt; border:solid windowtext 1.0pt; border-top:none; padding:0cm 0cm 0cm 0cm; background:white" width="104" | &nbsp;
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| style="width:2.0cm; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; padding:0cm 0cm 0cm 0cm; background:white" width="76" | &nbsp;
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| style="width:49.6pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; padding:0cm 0cm 0cm 0cm; background:white" width="66" | &nbsp;
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| style="width:42.5pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="57" | <p align="right" style="margin-bottom:.0001pt; text-align:right; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">95% CIs:</span></span></span></span></p>
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| style="width:70.9pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="95" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">-37% to 47%</span></span></span></span></p>
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| style="width:77.95pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">-0.20 to 0.25</span></span></span></span></p>
 +
| style="width:3.0cm; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="113" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">NNT 4 to INF;'''</span></span></span></span></p> <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">NNH'''</span></span></span><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">5 to INF</span></span></span></span></p>  
 
|-
 
|-
−
|^  |||||| <span style'''"display: block; text-align: right;"><span style'''"display: block; text-align: right;">95% Confidence Intervals:</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">-37% to 47%</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">-0.20 to 0.25</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">NNT ''' 4 to INF; NNH ''' 5 to INF</span></span>  
+
| style="width:77.75pt; border:solid windowtext 1.0pt; border-top:none; background:white" width="104" |  
 +
<span style="line-height:normal">'''<span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">Angiography - reperfusion</span></span></span>'''</span>
 +
 
 +
| style="width:2.0cm; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="76" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">3 weeks?</span></span></span></span></p>
 +
| style="width:49.6pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="66" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">0.595</span></span></span></span></p>
 +
| style="width:42.5pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="57" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">0.595</span></span></span></span></p>
 +
| style="width:70.9pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="95" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">0%</span></span></span></span></p>
 +
| style="width:77.95pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">0.000</span></span></span></span></p>
 +
| style="width:3.0cm; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="113" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">INF</span></span></span></span></p>  
 
|-
 
|-
−
| <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">Angiography - reperfusion </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">3 weeks?</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">0.595</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">0.595</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">0%</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">0.000</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">INF</span></span>  
+
| style="width:77.75pt; border:solid windowtext 1.0pt; border-top:none; padding:0cm 0cm 0cm 0cm; background:white" width="104" | &nbsp;
 +
| style="width:2.0cm; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; padding:0cm 0cm 0cm 0cm; background:white" width="76" | &nbsp;
 +
| style="width:49.6pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; padding:0cm 0cm 0cm 0cm; background:white" width="66" | &nbsp;
 +
| style="width:42.5pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="57" | <p align="right" style="margin-bottom:.0001pt; text-align:right; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">95% CIs:</span></span></span></span></p>
 +
| style="width:70.9pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="95" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">-38% to 38%</span></span></span></span></p>
 +
| style="width:77.95pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">-0.22 to 0.22</span></span></span></span></p>
 +
| style="width:3.0cm; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="113" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">NNT 4 to INF;'''</span></span></span></span></p> <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">NNH'''</span></span></span><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">4 to INF</span></span></span></span></p>  
 
|-
 
|-
−
|^  |||||| <span style'''"display: block; text-align: right;"><span style'''"display: block; text-align: right;">95% Confidence Intervals:</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">-38% to 38%</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">-0.22 to 0.22</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">NNT ''' 4 to INF; NNH ''' 4 to INF</span></span>  
+
| style="width:77.75pt; border:none; border-bottom:solid windowtext 1.0pt; background:white" width="104" |  
 +
&nbsp;
 +
 
 +
| style="width:2.0cm; border:none; border-bottom:solid windowtext 1.0pt; background:white" width="76" |  
 +
&nbsp;
 +
 
 +
| style="width:49.6pt; border:none; border-bottom:solid windowtext 1.0pt; background:white" width="66" |  
 +
&nbsp;
 +
 
 +
| style="width:42.5pt; border:none; border-bottom:solid windowtext 1.0pt; background:white" width="57" | <p align="right" style="margin-bottom:.0001pt; text-align:right; padding:0cm 0cm 0cm 0cm">&nbsp;</p>  
 +
| style="width:70.9pt; border:none; border-bottom:solid windowtext 1.0pt; background:white" width="95" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm">&nbsp;</p>  
 +
| style="width:77.95pt; border:none; border-bottom:solid windowtext 1.0pt; background:white" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm">&nbsp;</p>  
 +
| style="width:3.0cm; border:none; border-bottom:solid windowtext 1.0pt; background:white" width="113" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm">&nbsp;</p>  
 
|-
 
|-
−
| <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''Mean Outcome'''</span></span> |||| <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''Control Group'''</span></span> |||| <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''HBO Group'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''Difference'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''95% CI'''</span></span>  
+
| style="width:77.75pt; border:solid windowtext 1.0pt; border-top:none; padding:0cm 0cm 0cm 0cm; background:white" width="104" | &nbsp;
 +
| style="width:2.0cm; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; padding:0cm 0cm 0cm 0cm; background:white" width="76" | &nbsp;
 +
| style="width:49.6pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="66" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal">'''<span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">Control Group</span></span></span>'''</span></p>  
 +
| style="width:42.5pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; padding:0cm 0cm 0cm 0cm; background:white" width="57" | &nbsp;
 +
| style="width:70.9pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="95" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal">'''<span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">HBO Group</span></span></span>'''</span></p>  
 +
| style="width:77.95pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal">'''<span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">Difference</span></span></span>'''</span></p>  
 +
| style="width:3.0cm; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="113" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal">'''<span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">95% CI</span></span></span>'''</span></p>  
 
|-
 
|-
−
|^  || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''Mean'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''SD'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''Mean'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''SD'''</span></span> ||^  ||^ 
+
| style="width:77.75pt; border:solid windowtext 1.0pt; border-top:none; padding:0cm 0cm 0cm 0cm; background:white" width="104" | &nbsp;
 +
| style="width:2.0cm; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="76" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal">'''<span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">Mean</span></span></span>'''</span></p>  
 +
| style="width:49.6pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="66" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal">'''<span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">SD</span></span></span>'''</span></p>  
 +
| style="width:42.5pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="57" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal">'''<span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">Mean</span></span></span>'''</span></p>  
 +
| style="width:70.9pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="95" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal">'''<span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">SD</span></span></span>'''</span></p>  
 +
| style="width:77.95pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; padding:0cm 0cm 0cm 0cm; background:white" width="104" | &nbsp;
 +
| style="width:3.0cm; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; padding:0cm 0cm 0cm 0cm; background:white" width="113" | &nbsp;
 
|-
 
|-
−
| Peak CK value (U/L) || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">1529</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">1187</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">989</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">643</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">540</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">98.154 to 981.846</span></span>  
+
| style="width:77.75pt; border:solid windowtext 1.0pt; border-top:none; background:white" width="104" |
 +
<span style="line-height:normal">'''<span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">Peak CK value (U/L)</span></span></span>'''</span>
 +
 
 +
| style="width:2.0cm; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="76" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">1529</span></span></span></span></p>
 +
| style="width:49.6pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="66" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">1187</span></span></span></span></p>
 +
| style="width:42.5pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="57" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">989</span></span></span></span></p>
 +
| style="width:70.9pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="95" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">643</span></span></span></span></p>
 +
| style="width:77.95pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">540</span></span></span></span></p>
 +
| style="width:3.0cm; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="113" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">98.154 to 981.846</span></span></span></span></p>  
 
|-
 
|-
−
| <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''Non-Event Outcomes''' </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''Time to outcome''' </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''Control group''' </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''HBO group''' </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''P-value'''</span></span>  
+
| style="width:77.75pt; border:none; border-bottom:solid windowtext 1.0pt; background:white" width="104" |
 +
&nbsp;
 +
 
 +
| style="width:2.0cm; border:none; border-bottom:solid windowtext 1.0pt; background:white" width="76" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm">&nbsp;</p>  
 +
| style="width:49.6pt; border:none; border-bottom:solid windowtext 1.0pt; background:white" width="66" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm">&nbsp;</p>
 +
| style="width:42.5pt; border:none; border-bottom:solid windowtext 1.0pt; background:white" width="57" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm">&nbsp;</p>  
 +
| style="width:70.9pt; border:none; border-bottom:solid windowtext 1.0pt; background:white" width="95" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm">&nbsp;</p>  
 +
| style="width:77.95pt; border:none; border-bottom:solid windowtext 1.0pt; background:white" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm">&nbsp;</p>  
 +
| style="width:3.0cm; border:none; border-bottom:solid windowtext 1.0pt; background:white" width="113" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm">&nbsp;</p>  
 
|-
 
|-
−
| Echo - ejection fraction || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">3 weeks</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">44.05%</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">50.81%</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;"><.001</span></span>  
+
| style="width:77.75pt; border:solid windowtext 1.0pt; border-top:none; padding:0cm 0cm 0cm 0cm; background:white" width="104" | &nbsp;
 +
| style="width:2.0cm; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="76" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal">'''<span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">Time to outcome</span></span></span>'''</span></p>
 +
| style="width:49.6pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="66" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal">'''<span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">Control group</span></span></span>'''</span></p>
 +
| style="width:42.5pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="57" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal">'''<span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">HBO group</span></span></span>'''</span></p>
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| style="width:70.9pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="95" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal">'''<span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">P-value</span></span></span>'''</span></p>
 +
| style="width:77.95pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt; background:white" width="104" | &nbsp;
 +
| style="width:3.0cm; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt; background:white" width="113" | &nbsp;
 
|-
 
|-
 +
| style="width:77.75pt; border:solid windowtext 1.0pt; border-top:none; background:white" width="104" |
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<span style="line-height:normal">'''<span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">Echo - ejection fraction</span></span></span>'''</span>
 +
 +
| style="width:2.0cm; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="76" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">3 weeks</span></span></span></span></p>
 +
| style="width:49.6pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="66" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">44.05%</span></span></span></span></p>
 +
| style="width:42.5pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="57" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">50.81%</span></span></span></span></p>
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| style="width:70.9pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="95" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133"><.001</span></span></span></span></p>
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| style="width:77.95pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt; background:white" width="104" | &nbsp;
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| style="width:3.0cm; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt; background:white" width="113" | &nbsp;
 
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**<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">Comments:</span>'''
 
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1. Not clear if diagnosis was clinical at enrolment or after later on enzyme changes
 
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2. Exact details of randomisation and at what point patients were excluded is unclear.
 
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3. Results often presented graphically and as within group comparisons.4. Reperfusion was defined as reaching Thrombolysis in Myocardial Infarction (TIMI) trial classification 3.5. Mortality was the only clinical outcome.
 
  
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**Appraised by:''' James Hudgell, Department of Diving and Hyperbaric Medicine Prince of WalesHospital; Friday, 21 October 2005Email: '''Kill or Update By:''' June 2021
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&nbsp;
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<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Comments:</span></span></span>'''</span></span>
 +
 
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<span style="background:white"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">1. Not clear if diagnosis was clinical at enrolment or after later on enzyme changes</span></span></span></span></span>
 +
 
 +
<span style="background:white"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">2. Exact details of randomisation and at what point patients were excluded is unclear.</span></span></span></span></span>
 +
 
 +
<span style="background:white"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">3. Results often presented graphically and as within-group comparisons.</span></span></span></span></span>
 +
 
 +
<span style="background:white"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">4. Reperfusion was defined as reaching Thrombolysis in Myocardial Infarction (TIMI) trial classification 3.5. Mortality was the only clinical outcome.</span></span></span></span></span>
 +
 
 +
<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Appraised by:</span></span></span>'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">James Hudgell, Department of Diving and Hyperbaric Medicine Prince of Wales Hospital; Friday, 21 October 2005</span></span></span></span></span>
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<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Kill or Update By:</span></span></span>'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">June 2025</span></span></span></span></span>
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<span style="color: #7c00ff; display: block; font-size: 26px; text-align: center;">'''[[Acute ischaemia | BACK]]'''</span>
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Revision as of 03:56, 8 September 2021

Hyperbaric oxygen with thrombolysis in myocardial infarction: positive effect on cardiac echo indices

Clinical Bottom Line:

1. Hyperbaric oxygen with thrombolysis produced improvements in left ventricular function
2. The clinical significance is unclear

Citation/s:1. Dekleva MN, Ostojic M, Vujnovic D. Hyperbaric oxygen and thrombolysis in acute myocardial infarction: a preliminary report. In: Sitinen SA, Leinio M, eds. Proceedings of the Twenty-first Annual Meeting of the European Underwater and Baromedical Society (EUBS), Helsinki, Finland 1995:9-13 2. Dekleva M, Neskovic A, Vlahovic A et al. Adjunctive effect of hyperbaric oxygen treatment after thrombolysis on left ventricular function in patients with acute myocardial infarction. Am Heart J 2004; 148(4):589.

Lead author's name and fax:Milica Dekleva

Three-part Clinical Question:In patients suffering acute myocardial infarction, does the addition of hyperbaric oxygen therapy improve echocardiography / angiography results, when compared to standard therapy including a thrombolytic.

Search Terms:Myocardial infarction, echocardiography; thrombolytic therapy

The Study:Single-blinded (outcome observer) randomised controlled trial without intention-to-treat.

The Study Patients:<70 years old, chest pain unrelieved by anginine, ST-segment elevation, transient CK and/or MB isoenzyme rises, 1st echo within 24 hours of pain onset. Exclusions: previous MI, bypass surgery, unstable (arrhythmia, etc), heart failure, as well as standard thrombolytic and HBOT contraindications.

Control group(N = 37; 37 analysed): Streptokinase (1.5mU/L), followed by heparin.

Experimental group(N = 37; 37 analysed): As above, followed by HBOT: one treatment - 2.0 ATA for 60 minutes.

The Evidence:

 

Outcome

Time to Outcome

Control group

HBO group

Relative risk reduction

Absolute risk reduction

NNT

Cardiac Mortality

3 weeks?

0.027

0

100%

0.027

37

     

95% CI:

  

-0.03 to 0.08

NNT 13 to INF

 NNH40 to INF

Angiography - collaterals

3 weeks?

0.243

0.243

5%

0.027

37

     

95% CIs:

-37% to 47%

-0.20 to 0.25

NNT 4 to INF;

NNH5 to INF

Angiography - reperfusion

3 weeks?

0.595

0.595

0%

0.000

INF

     

95% CIs:

-38% to 38%

-0.22 to 0.22

NNT 4 to INF;

NNH4 to INF

 

 

 

 

 

 

 

   

Control Group

  

HBO Group

Difference

95% CI

 

Mean

SD

Mean

SD

    

Peak CK value (U/L)

1529

1187

989

643

540

98.154 to 981.846

 

 

 

 

 

 

 

 

Time to outcome

Control group

HBO group

P-value

    

Echo - ejection fraction

3 weeks

44.05%

50.81%

<.001

    

 

Comments:

1. Not clear if diagnosis was clinical at enrolment or after later on enzyme changes

2. Exact details of randomisation and at what point patients were excluded is unclear.

3. Results often presented graphically and as within-group comparisons.

4. Reperfusion was defined as reaching Thrombolysis in Myocardial Infarction (TIMI) trial classification 3.5. Mortality was the only clinical outcome.

Appraised by:James Hudgell, Department of Diving and Hyperbaric Medicine Prince of Wales Hospital; Friday, 21 October 2005

Kill or Update By:June 2025

 

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