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ISIS-2
About the Trial
The Second International Study of Infarct Survival randomized 17,187 heart attack patients to streptokinase, aspirin, both, or neither in a factorial design. Streptokinase reduced 5 week vascular mortality by 25 percent, aspirin by 23 percent, and together by 42 percent. Simple, cheap drugs delivered dramatic benefit. ISIS-2, run by Richard Peto and Rory Collins, pioneered large simple trials answering definitive questions fast. Aspirin became routine in the treatment of acute myocardial infarction, and thrombolysis spread worldwide. The trial also showcased the efficiency of factorial design, and its deliberately absurd astrological subgroup analysis became a classic warning about subgroup claims.
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