GISSI-2 trial

Last reviewed 01/2018

20891 patients who were admitted to hospital within 6 hr of the onset of symptoms of acute myocardial infarction were randomised to:


  • streptokinase (1.5 MU over 30-50 min)
  • t-PA (100 mg over 3 hr)


  • aspirin daily for 30 days (325 mg)
  • aspirin daily for 30 days plus subcutaneous heparin (12500 IU subcutaneous twice daily)

There were no significant differences in the 35 day mortality rates between:

  • streptokinase and t-PA
  • aspirin and aspirin+heparin

There was a small, but significant, increased incidence of stroke associated with t-PA.


  • Gruppo Italiano per lo Studio dell Streptochinasi nell' Infarcto Miocardico (GISSI). GISSI-2: A factorial randomised trial of alteplase versus streptokinase and heparin versus no heparin among 12490 patients with acute myocardial infarction. (1990). Lancet, 336, 65-71.
  • In hospital mortality and clinical course of 20891 patients with suspected acute myocardial infarction randomised between alteplase and streptokinase with or without heparin. (1990). Lancet, 335, 71-5.