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January 2, 1991

Intravenous Thrombolysis and Coronary Revascularization Rates-Reply

Author Affiliations

Sunnybrook Health Science Centre North York, Ontario Canada

Sunnybrook Health Science Centre North York, Ontario Canada

JAMA. 1991;265(1):29. doi:10.1001/jama.1991.03460010029019

In Reply.—  Dr Cheng notes a greater relative increase in revascularization procedures among patients treated with tissue plasminogen activator as compared with those given streptokinase. It is perhaps tempting to indulge in some speculation about this observation—eg, higher clot lysis rates with tissue plasminogen activator, or perhaps greater early lysis followed by higher rates of reocclusion. However, for all revascularization procedures, the actual odds ratios and confidence limits were reported as follows: tissue plasminogen activator: odds ratio, 2.25(95% confidence interval, 1.31 to 3.94), and streptokinase: odds ratio, 1.66(95% confidence interval, 1.08 to 259). The confidence limits clearly overlap and are compatible with random variation.These nonsignificant differences must also be considered in light of the trials themselves, which were done by different groups at different times. The three streptokinase trials were initiated between 1982 and 1984 and completed prior to August 1986, whereas the trials of tissue plasminogen activator ran