Coronary thrombolysis: mortality trials.

There is unequivocal evidence for the reduction of early mortality (up to about 35 days) by SK, APSAC and rt-PA, each compared with placebo, for patients treated intravenously within the first few hours of onset of acute MI. An overview of early trials demonstrating mortality reduction with SK, has been confirmed by three level I trials of SK, one level I trial of APSAC and one level I trial of rt-PA. The early benefits observed in the large trials of SK, APSAC and rt-PA have persisted at the one-year follow-up. The initial two large trials which directly compared mortalities of therapy with SK, rt-PA and APSAC detected no significant differences. However, the recently presented GUSTO trial has demonstrated greater mortality reduction with accelerated rt-PA plus heparin, compared with regimens of combined rt-PA/SK plus heparin, SK plus iv heparin, and SK plus sc heparin.