International study of infarct survival ISIS

Second International Study of Infarct Survival (ISIS-2)," Eaneetii, 349 (1988). 

Keavney B, McKenzie C, Parish S, Palmer A, Clark S, Youngman L et al. Large-scale test of hypothesised associations between the angiotensin-converting-enzyme insertion/deletion polymorphism and myocardial infarction in about 5000 cases and 6000 controls. International Studies of Infarct Survival (ISIS) Collaborators. Lancet 2000 355 434—442. 

Parish S, Collins R, Peto R, Youngman L, Barton J, Jayne K, Clarke R, Appleby P, Lyon V, Cederholm-Williams S, et al. Cigarette smoking, tar yields, and non-fatal myocardial infarction 14,000 cases and 32,000 controls in the United Kingdom. The International Studies of Infarct Survival (ISIS) Collaborators. BMJ 1995 311(7003) 471-7. 

Landmark clinical trials have established the role of early fi-blocker therapy in reducing MI mortality. Most of these trials were performed in the 1970s and 1980s before routine use of early reperfusion therapy. In the First International Study of Infarct Survival (ISIS-1), 16,027 patients with a suspected MI were randomized to IV atenolol 5 to 10 mg followed by atenolol 100 mg daily for 7 days or to no treatment. After 7 days, vascular death was reduced by 15% p <.04). Thebenefltwas apparent after 1 day of treatment(p <. 003), reflecting the ability of /S-blockers to prevent early reinfarction and sudden death. In the Metoprolol In Acute Myocardial Infarction (MIAMI) trial, 5778 patients with a suspected MI were randomized to IV metoprolol followed by oral metoprolol or placebo, and mortality was reduced from 4.9% to 4.3% (p = NS), and the occurrence of early progression to Q-wave MI also was reduced (p =. 024). ... 

INTERCEPT Incomplete Infarction Trial of European Research Collaborators Evaluating Prognosis post-Thrombolysis ISIS-1 First International Study of Infarct Survival ISIS-2 Second International Study of Infarct Survival IV intravenous LDL low-density lipoprotein LMWH low-molecular-weight heparin LVEF left ventricular ejection fraction MB myocardial band MI myocardial infarction... 

The second study was the European International Study of Infarct Survival (ISIS II) Trial (11). This study randomized patients suspected of having an AMI (there were no ECG inclusion criteria) to one of four arms placebo, aspirin only, streptokinase only, or streptokinase plus aspirin. Thus, this was the first large trial of combination therapy to evaluate the impact of treating both the fibrin and the platelet components of clot. Of 17,187 patients randomized, mortality at 30 days was lowered by 21% in those treated with streptokinase, from 13.2% in the placebo group to 10.4%, with a similar 19% reduction to 10.7% in those treated with aspirin alone. Those receiving both agents had a 39% reduction in mortality to 8.0% (p < 0.05 for all comparisons). These patients were enrolled up to 24 hours after symptom onset, and the median time to treatment was 5 hours. Heparin therapy was not included in the protocol regimen. 

Third International Study of Infarct Survival Collaborative Group (ISIS-3 trial). Lancet 339, 753 (1992). 

Baigent C, Collins R, Appleby P, Parish S, Sleight P, Peto R, for the ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. ISIS-2 10 year... 

ISIS-1 (First International Study of Infarct Survival) Collaborative Group. Lancet. 1988, i, 921. 

ISIS-2 (1988) (Second International Study of Infarct Survival) Collaborative Group Randomized trial of intravenous streptokinase, oral aspirin, both or neither among 17, 187 cases of suspected acute myocardial infarction ISIS-2. Lancet 2 349-360. 

ISIS-3 (Third International Study of Infarct Survival) Collaborative Group. ISIS-3 a randomised comparison of streptokinase vs tissue plasminogen activator vs anistre-plase and of aspirin plus heparin vs aspirin alone among 41,299 cases of suspected acute myocardial infarction. Lancet 1992 339(8796) 753-70. 

ISIS-4 (Fourth International Study of Infarct Survival Collaborative Group). ISIS-4 A randomised factorial trial assessing early oral capto-pril, oral mononitrate, and intravenous magnesium sulphate in 58,050 patients with suspected acute myocardial infarction. Lancet 1995 345 669-685. 

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