Nine RCTs involving 58,600 patients were included.
Mortality Outcomes.
Overall: fibrinolytic 9.6%, control 11.5%.
This is an 18% (standard deviation-squared, SD2) proportional reduction in 35-day mortality (95% confidence interval: 13, 23), which represents the avoidance of about 18 deaths per 1,000 patients allotted treatment.
Mortality rates were higher on the day of randomisation with an excess of 5 deaths per 1,000 patients allotted treatment.
There were significant trends towards greater proportional and absolute mortality reductions among patients treated earlier after symptom onset: 26% in patients presenting in less than 3 hours, 18% in patients presenting in 4 to 6 hours and 14% in patients presenting at 7 to 12 hours.
Older patients are at higher absolute risk of death from AMI, but absolute mortality reductions appear similar among older and younger patients.
The benefit of FT is highest amongst patients with bundle-branch block or ST elevation. Patients with ST depression or other ECG abnormalities showed no conclusive evidence of benefit.
Strokes and non-cerebral bleeding.
FT was associated with a small but significant number of extra strokes occurring within the first day, i.e. 3.9 (SD 0.8) per 1,000 patients, and also an extra 7.3(SD 0.7) nonfatal major bleeds per 1,000 patients.