One-Year Results From the Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries (GUSTO-I) Trial
- 15 September 1996
- journal article
- research article
- Published by Wolters Kluwer Health in Circulation
- Vol. 94 (6), 1233-1238
- https://doi.org/10.1161/01.cir.94.6.1233
Abstract
Background In the randomized Global Utilization of t-PA and Streptokinase for Occluded Coronary Arteries (GUSTO-I) trial, 41 021 patients received one of four thrombolytic regimens. Patients treated with accelerated tissue plasminogen activator (TPA) had a lower 30-day mortality rate (6.3%) than those treated with the other regimens (7.3%, combined streptokinase groups). Methods and Results Each patient who was alive at 30 days was sent a return postcard to ascertain vital status at 1 year. If the postcard was not returned, the patient (or an alternate specified at randomization) was contacted by telephone. A locator service was used in the United States for patients who could not be located by these methods. Final follow-up was 96% worldwide. One-year mortality rates remained in favor of accelerated TPA (9.1%) over streptokinase with subcutaneous heparin (10.1%, P=.011) and streptokinase with intravenous heparin (10.1%, P=.009). Combination therapy had an intermediate 1-year mortality (9.9%); this outcome was statistically indistinguishable from that with streptokinase (P=.47) but was marginally different from that with accelerated TPA (P=.05). Conclusions The 1-year results demonstrated a saving of 10 lives per 1000 patients treated with accelerated TPA versus streptokinase and subcutaneous or intravenous heparin. Combination thrombolytic therapy had an intermediate benefit but offered no advantage over accelerated TPA treatment alone.Keywords
This publication has 11 references indexed in Scilit:
- Early discharge in the thrombolytic era: An analysis of criteria for uncomplicated infarction from the global utilization of streptokinase and t-PA for occluded coronary arteries (GUSTO) trialJournal of the American College of Cardiology, 1996
- Cost Effectiveness of Thrombolytic Therapy with Tissue Plasminogen Activator as Compared with Streptokinase for Acute Myocardial InfarctionNew England Journal of Medicine, 1995
- Cardiogenic ShockNew England Journal of Medicine, 1994
- Holding GUSTO Up to the LightAnnals of Internal Medicine, 1994
- The Effects of Tissue Plasminogen Activator, Streptokinase, or Both on Coronary-Artery Patency, Ventricular Function, and Survival after Acute Myocardial InfarctionNew England Journal of Medicine, 1993
- An International Randomized Trial Comparing Four Thrombolytic Strategies for Acute Myocardial InfarctionNew England Journal of Medicine, 1993
- Hemodynamic, mechanical, and metabolic determinants of thrombolytic efficacy: A theoretic framework for assessing the limitations of thrombolysis in patients with cardiogenic shockAmerican Heart Journal, 1993
- Long-term effects of intravenous anistreplase in acute myocardial infarction: final report of the AIMS studyThe Lancet, 1990
- Long-term benefit of early thrombolytic therapy in patients with acute myocardial infarction: 5 year follow-up of a trial conducted by the Interuniversity Cardiology Institute of the NetherlandsJournal of the American College of Cardiology, 1989
- Periods of differing mortality distribution during the first year after acute myocardial infarctionThe American Journal of Cardiology, 1983