Clinical cardiology
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Clinical cardiology · Aug 1990
Comparative Study Clinical TrialThe GISSI-2 trial: premises, results, epidemiological (and other) implications. Gruppo Italiano per lo Studio delia Sopravvivenza nell'Infarto Miocardico.
Population trials on myocardial infarction have produced significant advances in therapeutic results. The first clearly stated aim of the GISSI-2 protocol was the assessment of the overall benefit to a population attributable to the application of a package of pharmacological treatments (thrombolysis, intravenous beta blockade, and oral aspirin) shown effective in reducing mortality in large-scale randomized clinical trials. At variance with the classical concept of trials, a clinical epidemiological interest came first: The comparison between drugs was considered a main target of the investigation only within that broader framework, and was explicitly formulated as the direct confrontation between two concepts or two generations of thrombolysis. ⋯ The main results of GISSI-2 are summarized. GISSI-2 may be considered a reliable window on the epidemiology of AMI in a whole country. There are implications for the transfer of these clinical findings into public health applications and for the choice of future research priorities.
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Clinical cardiology · Aug 1990
The earliest thrombolytic treatment of acute myocardial infarction: ambulance or emergency department?
Because the effectiveness of thrombolytic therapy is inversely related to the time interval before it is given, prehospital thrombolytic administration has been proposed and implemented to shorten the time between acute myocardial infarction (AMI) symptom onset and definitive therapy. Regardless of how effective these prehospital approaches prove to be, they have the potential to shorten the time to thrombolytic therapy in only a minority of the affected U. S. population because only approximately half of AMI patients are transported by the Emergency Medical Services (EMS) system. ⋯ If prehospital treatment were to become standard care in the United States, half of the 1.5 million AMI patients per year (750,000) who are transported by paramedics would be candidates for prehospital treatment. Assuming a 30% treatment rate (225,000), a 5% major bleed and a 1% stroke complication rate, then 11,250 major bleeds and 2,250 strokes would occur in field-treated AMI patients. If we assume that the absence of physician screening might increase the incidence of complications between 1% and 10%, then 113 to 1,125 extra bleeds and 23 to 225 extra strokes would result from prehospital treatment compared with treatment in the emergency department (ED).(ABSTRACT TRUNCATED AT 250 WORDS)