In the ISIS-2 trial, the combination of aspirin and streptokinase in STEMI reduced 35-day vascular mortality by approximately 42% compared with placebo. The individual contribution of aspirin alone was approximately:

• A 5% relative risk reduction
• B 23% relative risk reduction ✓
• C 37% relative risk reduction
• D 42% relative risk reduction

Explanation

ISIS-2 (Second International Study of Infarct Survival, 1988) demonstrated aspirin alone reduced 35-day vascular mortality by 23%, streptokinase alone by 25%, and their combination by 42% — a largely additive benefit. This established aspirin as an independent cornerstone of acute MI therapy. The mechanisms are complementary: thrombolysis restores flow while aspirin inhibits re-thrombosis via COX-1 inhibition of thromboxane A2.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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