Current issues concerning thrombolytic therapy for acute myocardial infarction
Why the study?
Does thrombolytic therapy and aspirin reduce mortality in patients with acute evolving myocardial infarction?
Population
Patients with acute evolving myocardial infarction presenting up to 12-24 hours after symptom onset
Comparison
Thrombolytic therapy and aspirin vs Direct comparison between thrombolytic agents…
Design
Review
Authors
Discussion
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Implication
Supports adjunctive aspirin with thrombolysis in evolving MI; leaves open optimal agent selection in contemporary reperfusion practice.
Key Points
- This research aims to evaluate the risks and benefits of thrombolytic agents in patients with acute myocardial infarction based on recent trials.
- Data derived from three large-scale randomized trials: GISSI-2, ISIS-3, and GUSTO-1.
- Comparison of thrombolytic agents including t-PA, streptokinase, APSAC, and aspirin.
- Analysis of mortality reduction associated with thrombolytic therapy and aspirin within specified time frames post-symptom onset.
- Thrombolytic therapy reduces mortality by approximately 20% when administered within 12 hours.
- Aspirin therapy reduces mortality by approximately 23% when given up to 24 hours after symptom onset.
- Streptokinase is associated with fewer strokes and cerebral hemorrhages compared to t-PA and APSAC.
Structured PICO
Does thrombolytic therapy and aspirin reduce mortality in patients with acute evolving myocardial infarction?
P
Population
Patients with acute evolving myocardial infarction presenting up to 12-24 hours after symptom onset
I
Intervention
Thrombolytic therapy (tissue-type plasminogen activator [t-PA], streptokinase, and anisoylated plasminogen streptokinase activator complex [APSAC]) and aspirin
C
Comparator
Direct comparison between thrombolytic agents, or no thrombolytic/aspirin therapy
O
Outcome
Mortalityhard clinical
Thrombolytic therapy and aspirin have additive mortality benefits in acute myocardial infarction, with streptokinase showing a lower risk of stroke and cerebral hemorrhage compared to t-PA or APSAC.
Cite This Study
Hennekens et al. (1995) studied this question.