A clinical trial comparing primary coronary angioplasty with tissue plasminogen activator for acute myocardial infarction

The New England Journal of Medicine
Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes (GUSTO IIb) Angioplasty Substudy Inv

Abstract

Among physicians who treat patients with acute myocardial infarction, there is controversy about the magnitude of the clinical benefit of primary (i.e., immediate) coronary angioplasty as compared with thrombolytic therapy. As part of the Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes (GUSTO IIb) trial, we randomly assigned, 1138 patients from 57 hospitals who presented within 12 hours of acute myocardial infarction (with ST-segment elevation on the electrocardiogram) to primary angioplasty or accelerated thrombolytic therapy with recombinant tissue plasminogen activator (t-PA). We also randomly assigned 1012 patients to heparin or hirudin treatment in a factorial design. The primary study end point was a composite outcome of death, nonfatal reinfarction, and nonfatal disabling stroke at 30 days. The incidence of the primary end point in the angioplasty and t-PA groups was 9.6 percent and 13.7 percent, respectively (odds ratio, 0.67; 95 percent confidence interval, 0.47 to 0.97; P = 0.033). Death occurred in 5.7 percent of the patients assigned to angioplasty and 7.0 percent of those assigned to t-PA (P=0.37), reinfarction in 4.5 percent and 6.5 percent (P=0.13), and disabling stroke in ...Continue Reading

References

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Citations

Jul 6, 2000·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·H L DauermanJ J Popma
Feb 15, 2001·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·D P LeeA C Yeung
Jul 12, 2002·Annals of Neurology·David T WinklerMathias Jucker
Aug 31, 2002·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Behzad TaghizadehAugustin DeLago
Oct 3, 2002·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·James W H BlakePeter N Ruygrok
Nov 1, 2002·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Huang-Joe WangYuan-Teh Lee
Sep 5, 2002·Statistics in Medicine·Thomas Lumley
Feb 4, 2005·Der Internist·M Kelm, B E Strauer
Apr 6, 2012·International Journal of Clinical Pharmacy·Ibrahim Al-ZakwaniJassim Al Suwaidi
Aug 6, 2005·Journal of Thrombosis and Thrombolysis·Efthymios N DeliargyrisDavid C Sane
Apr 10, 2012·Journal of Thrombosis and Thrombolysis·Harold L Dauerman, Burton E Sobel
Mar 17, 2004·Current Treatment Options in Cardiovascular Medicine·Daniel R. Guerra, C. Michael Gibson
Nov 30, 2012·Current Treatment Options in Cardiovascular Medicine·C El KhouryE Bonnefoy
May 21, 2005·The American Journal of Cardiology·Rajendra H MehtaChristopher B Granger
Mar 31, 1999·American Heart Journal·R H Mehta, E R Bates
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Aug 27, 2003·Metabolism: Clinical and Experimental·Irina OtelNicolas Danchin
Nov 21, 2000·Lancet·D HasdaiD R Holmes
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Apr 26, 2003·International Journal of Cardiology·Pedro Marques-VidalJean Ferrières
May 18, 1999·International Journal of Cardiology·C VassanelliI Loschiavo
May 18, 1999·International Journal of Cardiology·S B King
May 18, 1999·International Journal of Cardiology·S CoccoliniA Maresta
Jul 18, 2000·Journal of the American College of Cardiology·F BärH Wellens

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