Survival following thrombolytic therapy.

The results of the major mortality studies of thrombolytic drugs in myocardial infarction demonstrate that streptokinase, APSAC and t-PA reduce mortality significantly. Large studies (GISSI-2 comparing Genentech t-PA with streptokinase and ISIS-3 comparing streptokinase, APSAC and Wellcome t-PA) are currently under way to identify which, if any, of the above agents is the most effective. Review of the results of the reported studies has emphasized the importance of treatment being given as soon as practical after the onset of symptoms. It has also revealed that substantial benefit is achievable in patients often not considered to be candidates for thrombolytic therapy, such as those presenting for treatment between 6 and 24 h after symptom onset, and elderly patients. It is emphasized that important benefit may be missed in clinical practice in deciding who should, or should not, receive thrombolytic drug therapy by complying too rigidly to what were investigative clinical study entry criteria.