Ten-year follow-up of the first megatrial testing thrombolytic therapy in patients with acute myocardial infarction - Results of the Gruppo Italiano per lo Studio della Sopravvivenza nell'infarto-1 study
Mg. Franzosi et al., Ten-year follow-up of the first megatrial testing thrombolytic therapy in patients with acute myocardial infarction - Results of the Gruppo Italiano per lo Studio della Sopravvivenza nell'infarto-1 study, CIRCULATION, 98(24), 1998, pp. 2659-2665
Citations number
29
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Background-We conducted a 10-year follow-up of the 11712 patients with acut
e myocardial infarction randomized in the Gruppo Italiano per lo Studio del
la Sopravvivenza nell'Infarto-1 study, the first large trial assessing thro
mbolytic therapy.
Methods and Results-Information on survival at 10 years was obtained for th
e 93% of all randomized patients through the census offices of their towns
of residence. The difference in survival produced by streptokinase and sust
ained up to 1 year was still significant at 10 years (log-rank test, P=0.02
), with the absolute benefit of 19 (95% CI 1 to 37) lives saved per 1000 pa
tients treated. The time dependence of the extent of the benefit was confir
med, as the higher mortality rate reductions found in patients treated earl
ier were still present at 10 years. In the overall population, most of the
benefit was obtained before hospital discharge (RR 0.81, 95% CI 0.72 to 0.9
0), since no difference in survival between thrombolyzed and control patien
ts discharged alive was found at 10 years (RR 0.98, 95% CI 0.90 to 1.06). H
owever, a slight albeit nonsignificant divergence of the survival curves of
patients randomized within the first hour was observed [90 (95% CI 34 to 1
46) lives saved per 1000 at 10 years versus 72 (95% CI 37 to 107) lives sav
ed at hospital discharge].
Conclusions-The benefits of a single intravenous infusion of 1.5 million un
its of streptokinase in prolonging survival of patients with acute myocardi
al infarction is sustained up to 10 years, with a still-evident trend in fa
vor of the patients admitted earlier.