Sep 2, 1993

An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction

The New England Journal of Medicine
GUSTO investigators

Abstract

The relative efficacy of streptokinase and tissue plasminogen activator and the roles of intravenous as compared with subcutaneous heparin as adjunctive therapy in acute myocardial infarction are unresolved questions. The current trial was designed to compare new, aggressive thrombolytic strategies with standard thrombolytic regimens in the treatment of acute myocardial infarction. Our hypothesis was that newer thrombolytic strategies that produce earlier and sustained reperfusion would improve survival. In 15 countries and 1081 hospitals, 41,021 patients with evolving myocardial infarction were randomly assigned to four different thrombolytic strategies, consisting of the use of streptokinase and subcutaneous heparin, streptokinase and intravenous heparin, accelerated tissue plasminogen activator (t-PA) and intravenous heparin, or a combination of streptokinase plus t-PA with intravenous heparin. ("Accelerated" refers to the administration of t-PA over a period of 1 1/2 hours--with two thirds of the dose given in the first 30 minutes--rather than the conventional period of 3 hours.) The primary end point was 30-day mortality. The mortality rates in the four treatment groups were as follows: streptokinase and subcutaneous hepar...Continue Reading

  • References15
  • Citations1669

Citations

Mentioned in this Paper

Cerebrovascular Occlusion
Subcutaneous heparin
Liquaemin
Myocardial Infarction
Polychemotherapy
Streptokinase
Plasminogen Activator Activity
Actilyse
Physiological Reperfusion
Regression Analysis

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