Key result
Streptokinase plus aspirin cuts 5-week vascular mortality ~42% in acute myocardial infarction.
Why the study?
Before the 1980s, treatment of AMI was largely supportive, and recognizing coronary thrombosis as the principal mechanism underlying ST-segment elevation myocardial infarction led to the development of thrombolytic reperfusion strategies evaluated in the landmark GISSI, ISIS, and TIMI trials.
Does intravenous thrombolytic therapy and aspirin reduce mortality and improve coronary reperfusion in patients with acute myocardial infarction?
Does intravenous thrombolytic therapy and aspirin reduce mortality and improve coronary reperfusion in patients with acute myocardial infarction?
This narrative review summarizes how the landmark GISSI, ISIS, and TIMI trials established the efficacy of intravenous thrombolytic therapy and aspirin in reducing mortality in acute myocardial infarction while pioneering the methodology of large simple clinical trials.
The introduction of thrombolytic therapy represents one of the most important advances in the history of cardiovascular medicine. Before the 1980s, treatment of acute myocardial infarction (AMI) was largely supportive, with limited opportunities to modify the natural course of the disease. The recognition that coronary thrombosis was the principal mechanism underlying ST-segment elevation myocardial infarction led to the development of reperfusion strategies aimed at restoring coronary blood flow and limiting myocardial damage. Among the landmark investigations that established the efficacy of thrombolytic therapy, the GISSI, ISIS, and TIMI trials occupy a central place. GISSI demonstrated for the first time on a large scale that intravenous streptokinase reduced mortality after AMI. ISIS confirmed and expanded these findings by documenting the additive benefits of aspirin, while TIMI advanced the understanding of coronary reperfusion through systematic angiographic assessment. Together, these programs transformed the management of acute myocardial infarction and established many of the principles that continue to guide reperfusion therapy today.
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Maggioni et al. (2026) conducted a review in Acute myocardial infarction (STEMI). Intravenous thrombolytic therapy (streptokinase, recombinant tissue plasminogen activator) and aspirin vs. Conventional supportive therapy or placebo was evaluated. Intravenous streptokinase plus aspirin reduced 5-week vascular mortality by approximately 42% in ISIS-2, while GISSI-1 and TIMI established the survival and angiographic benefits of thrombolysis.
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