The management of ST-elevation myocardial infarction (STEMI) has evolved significantly with the introduction of new pharmacological therapies as well as interventional procedures and devices. The GISSI and ISIS-2 studies showed a mortality benefit of streptokinase over standard therapy (heparin ± oral anticoagulation)/placebo which lead to the widespread use of streptokinase in the late 1980s [1, 2]. The use of recombinant tissue plasminogen activator (rt-PA) was shown to be more beneficial than streptokinase in the TIMI and GUSTO trials [3, 4]. Results of other studies such as CLARITY and COMMIT paved the way for addition of clopidogrel to the drug regime which further reduced mortality [5, 6].
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