Author + information
- Received June 17, 1986
- Revision received July 29, 1986
- Accepted August 20, 1986
- Published online January 1, 1987.
- Rolf Schröder, MD, FACC*,α,
- Karl-Ludwig Neuhaus, MD†,
- Alain Leizorovicz, MD‡,
- Thomas Linderer, MD*,
- Ulrich Tebbe, MD†,
- Isam Study Group
- ↵αAddress for reprints: Rolf Schröder, MD. ISAM Coordinating Center. Klinikum Steglitz, Haus 111. Hindenburgdamm 30, 1000 Berlin 45, West Germany.
Long-term mortality and morbidity of 1,741 patients with acute myocardial infarction, treated with intravenous streptokinase (1.5 million IU/h) or placebo, was assessed in a double-blind placebo-controlled trial (ISAM). At the 7 month follow-up, 94 (10.9% ) of the 859 patients in the streptokinase group and 98 (11.1%) of the 882 patients in the placebo group had died; at an average follow-up of 21 months, 14.4% of the streptokinase group and 16.1% of the placebo group had died. The differences were not statistically significant.
Long-term mortality was slightly higher in patients with anterior myocardial infarction and streptokinase treatment (20.1 versus 18.4%) and lower in patients with inferior myocardial infarction (10.2 versus 14.2%). Patients with previous myocardial infarction had a higher long-term mortality rate with streptokinase (34.9 versus 21.5% with placebo, p = 0.03). At 7 months, there were significantly more cases of reinfarction in the streptokinase group (7.2 versus 4.5%, p = 0.02).
It is concluded that despite a significant limitation of infarct size by intravenous streptokinase, long-term mortality is only slightly reduced and reinfarction is significantly more frequent. Both findings suggest the need for complementary therapy such as revascularization procedures after thrombolysis.
- Received June 17, 1986.
- Revision received July 29, 1986.
- Accepted August 20, 1986.
- American College of Cardiology