A Review of Thrombolysis Mortality Trials: ISAM to ASSET

Large controlled mortality studies with streptokinase, APSAC or tissue plasminogen activator (tPA) have conclusively shown that thrombolytic therapy within 6 hours after symptom onset improves survival after acute myocardial infarction. There is evidence of benefit even for patients treated between 7–24 hours after pain onset, suggesting that early recanalization of the infarct‐related artery is not the only mechanism by which thrombolysis improves survival. There is no apparent upper age limit for thrombolytic therapy. Serious side effects are generally rare and not age dependent. Inclusion criteria as well as concomittant adjuvant therapy were different in the various trials. Furthermore, the 95% confidence intervals for mortality reduction by different thrombolytic agents are overlapping. To evaluate their relative efficacy and safety direct head‐to‐head comparison is needed.