I believe streptokinase is still the trombolytic of choice for the majority of @entity1 with @entity583 for the following reasons: 1. The superiority of alteplase over streptokinase rests on insecure grounds, statistically (when net clinical benefit is computed for the SK/subcutaneous heparin arm versus the accelerated @entity3479 arm, the P value is only 0.04). 2. The excess of @entity1779 with @entity3479 is statistically highly significant and consistent over all trials. 3. @entity1 at greater risk of @entity1779 are those with raised systolic arterial pressure above about 130 to 140 on admission and those aged over about 55 years. These comprise the majority of @entity1 admitted to ordinary Coronary Care Units. If @entity3479 is given to @entity1 at low risk of @entity1779 , the extra cost per life saved will be very high, since such @entity1 are at relatively low risk in any case. 4. The open design of the GUSTO-2 trial (the only trial showing a small mortality benefit for accelerated @entity3479 versus SK) introduces the possibility of bias. For example, unfamiliarity with SK in North American centers may have given risk to premature stopping of treatment because of @entity551 ; this might have resulted in a more favorable experience for accelerated @entity3479 in North American centers compared with the rest of the world. (The mortality benefit for accelerated @entity3479 in the GUSTO trial was seen only in North American centers.)

Streptokinase Is Still the Agent of Choice for Most @entity1 with XXXX .

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients'] @entity583 :: ('MESH:D009203', 'Disease') :: ['acute myocardial infarction'] @entity3479 :: ('5327', 'Gene') :: ['t-PA'] @entity551 :: ('MESH:D007022', 'Disease') :: ['hypotension'] @entity1779 :: ('MESH:D002543', 'Disease') :: ['cerebral haemorrhage', 'cerebral hemorrhage']
@entity583 :: (MESH:D009203,Disease) :: ['Myocardial Infarction']
