- Question
- To determine whether intravenous streptokinase, oral aspirin, or both reduce vascular mortality in patients with suspected acute myocardial infarction compared with placebo.
- Design
- Randomised, placebo-controlled 2x2 factorial trial enrolling 17187 patients in 417 hospitals. Patients entered up to 24 hours (median 5 hours) after pain onset.
- Population
- Patients with suspected acute myocardial infarction enrolled within 24 hours of symptom onset.
- Intervention
- Intravenous streptokinase 1.5 MU infused over 1 hour, enteric-coated aspirin 160 mg/day for one month, or both treatments.
- Control
- Placebo infusion and placebo tablets (neither active treatment).
- Primary outcome
- Vascular mortality at 5 weeks.
- Results
- Vascular mortality was 9.2% with streptokinase vs 12.0% with placebo (odds reduction 25%, 2p < 0.00001) and 9.4% with aspirin vs 11.8% with placebo (odds reduction 23%, 2p < 0.00001). The combination reduced mortality from 13.2% to 8.0% versus neither treatment (odds reduction 42%; 95% CI 34-50%), with additive effects.
- Safety
- Streptokinase was associated with more bleeds requiring transfusion (0.5% vs 0.2%) and more confirmed cerebral haemorrhage (0.1% vs 0.0%), with no increase in total strokes (0.7% vs 0.8%). Aspirin was not associated with a significant increase in cerebral haemorrhage or bleeds requiring transfusion.
- Conclusion
- Streptokinase and aspirin each reduce mortality in acute myocardial infarction, and their combination provides an even greater benefit.
- Why it matters
- It showed that an inexpensive, widely available fibrinolytic and antiplatelet agent improve survival in acute myocardial infarction and complement each other, laying the foundation for initial infarct treatment.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 7, 2026