Thrombolytics Given for Major Heart Attack (STEMI)

43 for mortality

Benefits in NNT

1 in 43 were helped (life saved, given within 6 hours)
1 in 63 were helped (life saved, given between 6-12 hours)
1 in 200 were helped (life saved, given between 12-24 hours)
In the best case (given within 6 hours): 97.7% saw no benefit
In the best case (given within 6 hours): 2.3% were helped by being saved from death

Harms in NNT

1 in 143 were harmed (major bleeding episode)
1 in 250 were harmed (hemorrhagic stroke)
In the best case (given within 6 hours): 0.7% were harmed by a major bleeding event
In the best case (given within 6 hours): 0.4% were harmed by a hemorrhagic stroke
View As:

Efficacy Endpoints

Death at 1 month following acute heart attack (STEMI)

Harm Endpoints

Major bleeding (brain bleeding or bleeding requiring transfusion).


This systematic review includes 9 trials and 58600 patients randomized to receive a fibrinolytic drug or placebo for suspected heart attack. Patients were enrolled based on strong suspicion of heart attack by the treating doctor. Most (76%) were men, and most had ST-elevations on their EKG (68%). There was an overall mortality benefit of 1.9% (9.6 vs. 11.5) in favor of fibrinolytics. There was also a 0.4% increase in hemorrhagic stroke (1.2 vs. 0.8). Benefit was demonstrably greater with earlier treatment, with the most benefit apparent for treatment given within a few hours of symptom onset. Benefits were smaller and less statistically robust in the 12 to 24 hour period. Patients with ST-depressions were harmed rather than helped.


There was no gold standard to prove STEMI (e.g. catheterization or biomarkers) and some patients had normal EKG’s (5%). There is heterogeneity between trials, including inconsistency in the use of aspirin. However, groups appear to have been randomized well and treated equally with respect to other interventions.


Joshua Quaas, MD


January 19, 2010