A controlled clinical trial comparing streptokinase plus heparin with heparin alone in acute myocardial infarction of less than 12 hours' duration has been conducted in three hospitals in Italy. All the patients were managed in coronary-care units with continuous electrocardiographic monitoring and intensive medical and nursing care. On admission the patients were randomly allocated to heparin or to streptokinase-both drugs being given in standard doses. 321 patients were included in the trial, and survivors were followed up for 40 days; 164 were treated with streptokinase and 157 formed the control group. The total mortality in the streptokinase group was 19 patients (11·6%) and in the control group 18 (11·5%). The frequency of heart-failure, shock, arrhythmias, and non-transmural infarctions did not differ significantly between the two treatment groups. These results do not suggest that streptokinase therapy would reduce the morbidity and the mortality in patients with acute myocardial infarction treated in coronary-care units with the dosage and selection of cases used in this trial.
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