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Current issues concerning thrombolytic therapy for acute myocardial infarction
C H Hennekens1, C J O'Donnell, P M Ridker
1Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Journal of the American College of Cardiology
|June 1, 1995
Summary
Thrombolytic agents and aspirin significantly reduce mortality in acute myocardial infarction. Early and widespread use of these treatments, especially streptokinase, saves lives and has fewer side effects like stroke.
Area of Science:
- Cardiology
- Emergency Medicine
- Pharmacology
Background:
- Acute myocardial infarction (AMI) treatment relies on reperfusion strategies.
- Thrombolytic agents are crucial for restoring blood flow in AMI.
- Comparative data on different thrombolytics and adjunct therapies are essential.
Purpose of the Study:
- To compare the risks and benefits of thrombolytic agents in acute myocardial infarction.
- To interpret findings from major randomized trials like GISSI-2, ISIS-3, and GUSTO-1.
- To clarify the efficacy and safety profiles of tissue-type plasminogen activator (t-PA), streptokinase, and APSAC.
Main Methods:
- Analysis of data from three large-scale randomized trials (GISSI-2, ISIS-3, GUSTO-1).
- Direct comparison of thrombolytic agents and aspirin in patients with acute myocardial infarction.
- Evaluation of mortality rates, stroke incidence, and cerebral hemorrhages.
Main Results:
- Thrombolytic agents (t-PA, streptokinase, APSAC) reduce mortality in AMI.
- Thrombolytic therapy within 12 hours reduces mortality by ~20%; aspirin within 24 hours reduces it by ~23%.
- Streptokinase shows significantly fewer strokes and cerebral hemorrhages compared to t-PA or APSAC.
Conclusions:
- Early and widespread use of thrombolytic therapy and aspirin can save numerous lives.
- Streptokinase appears safer regarding cerebrovascular events than t-PA or APSAC.
- The mortality benefit of accelerated t-PA remains less conclusive compared to its safety profile.