Comparative analysis of long-term mortality after thrombolytic therapy.

In patients with acute myocardial infarction, thrombolytic therapy has a demonstrable and favorable impact on a range of clinical indicators, including left ventricular function, infarct size, coronary arterial patency, and symptom relief. However, these indicators have not provided a reliable basis for the comparison of thrombolytic regimens; mortality provides the "gold standard." One-year mortality obviates the differences in the timing of short-term comparisons (in-hospital, 30-day, or 5-week). In addition, late effects of differences in patency, including the impact of reocclusion, infarct healing, and remodeling, will be evident by 1 year. Meta-analysis of data from previous major mortality studies shows that differences in design and the overlap of confidence intervals of mortality studies suggest that no thrombolytic agent is superior in terms of short-term mortality. Long-term survival may provide a more meaningful basis for comparison of efficacy of the thrombolytic regimens. Long-term mortality has been evaluated for anistreplase in acute myocardial infarction in a composite analysis, similar to a meta-analysis. From the pooled life table analysis of all anistreplase studies, the odds reduction in mortality at 1 year was approximately 48%.