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Large-Scale Trials of Thrombolytic Therapy for Acute Myocardial Infarction: GISSI-2, ISIS-3, and GUSTO-1

Paul M. Ridker, MD; Christopher O'Donnell, MD; Victor J. Marder, MD; and Charles H. Hennekens, MD
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Brigham and Women's Hospital, Boston, MA 02215-1204. University of Rochester, Rochester, NY 14642. Harvard Medical School, Boston, MA 02215. Requests for Reprints: Paul M. Ridker, MD, Division of Preventive Medicine, Brigham and Women's Hospital, 900 Commonwealth Avenue East, Boston, MA 02215-1204.

Copyright 2004 by the American College of Physicians

Ann Intern Med. 1993;119(6):530-532. doi:10.7326/0003-4819-119-6-199309150-00017
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With the release of the GUSTO-1 (Global Utilization of Streptokinase and Tissue Plasminogen Activator to Treat Occluded Arteries [1]) study results, data are now available from three large-scale randomized trials that directly compared the thrombolytic agents most commonly used in the United States (Table 1). When examined both individually and together, these three trials show, at most, small absolute differences among agents, in terms of both lives saved and major complications (including hemorrhagic stroke). All three trials also indicate that the choice of thrombolytic agent is less important for patient survival than the delay time to initiation of treatment. This time period often includes long in-hospital delays owing to inadequate emergency room staffing and inadequate training in the appropriate administration of thrombolytic therapy.

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