[Effects of thrombolytic treatments on the mortality of myocardial infarction. Characteristics of large-scale trials, main results].

The characteristic features and principal results of the 5 large-scale randomised therapeutic trials (GISSI, ISIS 2, ASSET, AIMS, ISAM), each including over 1000 patients, designed to evaluate the effects of thrombolysis on mortality in myocardial infarction, are reviewed. The methodologies are very different, which prevents comparison of results. The thrombolytic therapy significantly reduced hospital mortality in all the trials except ISAM. Early institution of therapy gave better results but one trial (ISIS 2) showed persistence of a significant benefit in patients treated late up to the 24th hour and in the most elderly groups of patients (up to and over 70 years of age). The benefits obtained during the hospital phase were maintained at medium term. The tolerance was satisfactory, the frequency of complications being comparable in all the trials. The association of aspirin therapy significantly reduced mortality and occurrence of myocardial infarction in the ISIS 2 trial and would seem to be therefore a recommended association with streptokinase and probably with other thrombolytic drugs. Other trials are needed to compare the efficacy of the different thrombolytic agents in reducing patient mortality.