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Centre for Evidence-
Based Medicine

MI-streptokinase saves lives

Clinical Bottom Line

Streptokinase improves survival in patients with MI. Cost of treatment is a major issue for Filipinos. Patients should be involved in the decision.

Citation

ISIS-2 Collaborative Group. ISIS-2. Lancet 1988; ii:349-360.

Clinical Question

Among Filipino patients with suspected MI, will administration of streptokinase decrease in-hospital mortality?

Search Terms

'streptokinase' [MESH] and 'myocardial infarction' [MESH] and 'mortality' [MESH] from Cochrane Library

The Study

  • Double-blinded concealed randomised controlled trial with intention-to-treat.
  • The Study Patients: 17187 patients with suspected AMI
  • Control group (N = 8595): matching placebo infusion
  • Experimental group (N = 8592): 1.5 million units of streptokinase infused for 1 hour

The Evidence

Outcome Time to Outcome CER EER RRR ARR NNT
Vascular Deaths 0.120 0.092 23% 0.028 36
95% Considence Intervals 16% to 31% 0.019 to 0.037 27 to 53

Comments

  1. Early survival advantage and persists for several years.
  2. Kill or Update By: 2001

Summary

  1. You determined that the trial is valid and you were able to look into the results of the trial by applying the guides on therapeutic effectiveness.
  2. You were able to demonstrate by using the guides on applicability that evidences derived from foreign trials can be applied to the local setting without the need for repeating the RCT.
  3. From the whole process, you were able to determine the importance of the evidence and more significantly, appreciate its application in clinical practice.
  4. The data you gathered can now be used in convincing the hospital board on the effectiveness of streptokinase in decreasing in-hospital mortality. Efficiency of treatment, of course, is dependent on a number of factors that should be considered.
  5. Overall, the method not only reinforced clinical decision making, but placed emphasis on its value in making hospital-wide decisions.

References

  1. Baigent C, Collins R, Appleby P, et. al. ISIS-2: 10 year survival among patients with suspected myocardial infarction in randomised comparison of intravenous streptokinase, oral aspirin, both or neither. BMJ 1998; 316:1337-1343.
  2. Dans AL, Dans LF, Guyatt GH, Richardson S for the Evidence-Based Medicine Working Group. User's Guides to the Medical Literature. XIV. How to Decide on the Applicability of Clinical Trial Results to Your Patient. JAMA 1998;279(7):545-549.
  3. Guyatt GH, Sackett DL, Cook DJ, for the Evidence-Based Medicine Working Group. User's Guides to the Medical Literature. II. How to Use an Article About Therapy or Prevention. A. Are the Results of the Study Valid? JAMA 1993; 270(21):2598-2601.
  4. Guyatt GH, Sackett DL, Cook DJ for the Evidence-Based Medicine Working Group. User's Guide to the Medical Literature. II. How to Use an Article About Therapy or Prevention. B. What Were the Results and Will They Help Me in Caring for My Patients? JAMA 1994; 271(1):59-63.
  5. ISIP Study Group. Acute Myocardial Infarction in Tertiary Centers in Metro Manila: In-Hospital Survival and Physicians' Practices. Unpublished data, 1996.