User:Ewingdo/sandbox/ISIS (trial)

The ISIS (International Study of Infarct Survival) clinical trials are a series of influential studies in the field of cardiology, focused on improving treatments and outcomes for patients experiencing acute myocardial infarction (heart attack). These trials have had a significant impact on the management of heart attacks globally.^[1] Here are the key ISIS trials:

ISIS-1 Trial (1986)

Objective: To determine the effect of the beta-blocker atenolol on mortality in patients with suspected acute myocardial infarction.^[2]

Design: Randomized controlled trial involving over 16,000 patients.

Results: Demonstrated a significant reduction in mortality in patients treated with atenolol compared to placebo.

Conclusion: Established the benefit of beta-blockers in the early treatment of heart attacks.

ISIS-2 Trial (1988)

Objective: To evaluate the effects of aspirin, streptokinase, and the combination of both in patients with suspected acute myocardial infarction.^[3]

Design: Randomized controlled trial involving over 17,000 patients.

Results: Showed that both aspirin and streptokinase independently reduced mortality, and the combination had an additive effect.

Conclusion: Highlighted the lifesaving benefits of aspirin and thrombolytic therapy in heart attack management.

ISIS-3 Trial (1992)

Objective: To compare different thrombolytic agents (streptokinase, tissue plasminogen activator, and anistreplase) in the treatment of acute myocardial infarction.^[4]

Design: Randomized controlled trial with over 41,000 patients.

Results: Found no significant differences in overall mortality between the different thrombolytic agents.

Conclusion: Supported the use of multiple thrombolytic agents as effective treatments for heart attacks.

ISIS-4 Trial (1995)

Objective: To assess the effects of early treatment with captopril, oral mononitrate, and intravenous magnesium in patients with suspected acute myocardial infarction.^[5]

Design: Randomized controlled trial with over 58,000 patients.

Results: Found benefits with captopril, no significant benefit with oral mononitrate, and potential harm with intravenous magnesium.

Conclusion: Reinforced the role of ACE inhibitors (like captopril) in the early management of heart attacks.

Impact and Legacy

The ISIS trials significantly influenced clinical guidelines and practices for the management of acute myocardial infarction. They provided robust evidence for the use of beta-blockers, aspirin, thrombolytics, and ACE inhibitors in improving patient outcomes after a heart attack.

References ISIS-1 (1986). "Randomised trial of intravenous atenolol among 16,027 cases of suspected acute myocardial infarction: ISIS-1." The Lancet. ISIS-2 (1988). "Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2." The Lancet. ISIS-3 (1992). "ISIS-3: a randomised comparison of streptokinase vs tissue plasminogen activator vs anistreplase and of aspirin plus heparin vs aspirin alone among 41,299 cases of suspected acute myocardial infarction." The Lancet. ISIS-4 (1995). "ISIS-4: a randomised factorial trial assessing early oral captopril, oral mononitrate, and intravenous magnesium sulphate in 58,050 patients with suspected acute myocardial infarction." The Lancet.

^ Hennekens, Charles H. (February 1998). "Trials of Thrombolytic Therapy : The International Studies of Infarct Survival Experience". Journal of Interventional Cardiology. 11 (1): 1–7. doi:10.1111/j.1540-8183.1998.tb00089.x.
^ "RANDOMISED TRIAL OF INTRAVENOUS ATENOLOL AMONG 16 027 CASES OF SUSPECTED ACUTE MYOCARDIAL INFARCTION: ISIS-1". The Lancet. 328 (8498): 57–66. July 1986. doi:10.1016/S0140-6736(86)91607-7.
^ "RANDOMISED TRIAL OF INTRAVENOUS STREPTOKINASE, ORAL ASPIRIN, BOTH, OR NEITHER AMONG 17 187 CASES OF SUSPECTED ACUTE MYOCARDIAL INFARCTION: ISIS-2". The Lancet. 332 (8607): 349–360. August 1988. doi:10.1016/S0140-6736(88)92833-4.
^ "ISIS-3: a randomised comparison of streptokinase vs tissue plasminogen activator vs anistreplase and of aspirin plus heparin vs aspirin alone among 41 299 cases of suspected acute myocardial infarction". The Lancet. 339 (8796): 753–770. March 1992. doi:10.1016/0140-6736(92)91893-D.
^ "ISIS-4: A randomised factorial trial assessing early oral captopril, oral mononitrate, and intravenous magnesium sulphate in 58 050 patients with suspected acute myocardial infarction". The Lancet. 345 (8951): 669–685. March 1995. doi:10.1016/S0140-6736(95)90865-X.

[1] Hennekens, Charles H. (February 1998). "Trials of Thrombolytic Therapy : The International Studies of Infarct Survival Experience". Journal of Interventional Cardiology. 11 (1): 1–7. doi:10.1111/j.1540-8183.1998.tb00089.x.

[2] "RANDOMISED TRIAL OF INTRAVENOUS ATENOLOL AMONG 16 027 CASES OF SUSPECTED ACUTE MYOCARDIAL INFARCTION: ISIS-1". The Lancet. 328 (8498): 57–66. July 1986. doi:10.1016/S0140-6736(86)91607-7.

[3] "RANDOMISED TRIAL OF INTRAVENOUS STREPTOKINASE, ORAL ASPIRIN, BOTH, OR NEITHER AMONG 17 187 CASES OF SUSPECTED ACUTE MYOCARDIAL INFARCTION: ISIS-2". The Lancet. 332 (8607): 349–360. August 1988. doi:10.1016/S0140-6736(88)92833-4.

[4] "ISIS-3: a randomised comparison of streptokinase vs tissue plasminogen activator vs anistreplase and of aspirin plus heparin vs aspirin alone among 41 299 cases of suspected acute myocardial infarction". The Lancet. 339 (8796): 753–770. March 1992. doi:10.1016/0140-6736(92)91893-D.

[5] "ISIS-4: A randomised factorial trial assessing early oral captopril, oral mononitrate, and intravenous magnesium sulphate in 58 050 patients with suspected acute myocardial infarction". The Lancet. 345 (8951): 669–685. March 1995. doi:10.1016/S0140-6736(95)90865-X.

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