Author + information
- Received March 26, 1991
- Revision received June 7, 1991
- Accepted June 25, 1991
- Published online November 15, 1991.
- Ernest Scott Monrad, MD∗
- ↵∗Address for reprints: Ernest Scott Monrad, MD, Cardiac Catheterization Laboratory, Hospital of the Albert Einstein College of Medicine, 1825 Easchesler Road, Bronx, New York 10461.
The (Thrombolysis in Myocardial Infarction) TIMI-I trial led to the hypothesis that the greater reperfusion rate seen with recombinant tissue-type plasminogen activator (rt-PA) versus streptokinase would result in greater reductions in infarct size and mortality in patients with acute myocardial infarction. Despite extensive investigation, no trial comparing rt-PA with streptokinase (European Cooperative Study Group, Plasminogen Activator Italian Multicenter Study [PAIMS], Gruppo Italiano per lo Studio della Sopravvivenze nell'Infarto Miocardico [GISSI-2]. International Study on Infarct Survival [ISIS-3], even TIMI-I itself) nor rt-PA and anisoylated plasminogen-streptokinase activator complex (APSAC or anistreplase) (Bassand, TEAM-3, ISIS-3), have confirmed this hypothesis.
In a reversal of traditional scientific method, the studies, rather than the unconfirmed hypothesis, have been rejected. A lack of independent review of this subject may have contributed to this outcome. It is proposed that standards of review and editorial comment mandating true critical distance and independence be followed, permitting greater independence of scientific inquiry, review and debate.
☆ Editorials published in Journal of the American College of Cardiologyreflect the views of the authors and do not necessarily represent the views of JACC or the American College of Cardiology.
- Received March 26, 1991.
- Revision received June 7, 1991.
- Accepted June 25, 1991.