1 / 5

GUSTO-I: Global Utilization of Streptokinase and t-PA for Occluded coronary arteries - I

wilma
Download Presentation

GUSTO-I: Global Utilization of Streptokinase and t-PA for Occluded coronary arteries - I

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. GUSTO-I: Global Utilization of Streptokinase and t-PA for Occluded coronary arteries - I Purpose To compare an aggressive thrombolytic strategy using accelerated tissue plasminogen activator (t-PA) with standard thrombolytic strategies in the treatment of acute myocardial infarction Reference The GUSTO Investigators. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med 1993;329:673-82.

    2. GUSTO-I: Global Utilization of Streptokinase and t-PA for Occluded coronary arteries - I - TRIAL DESIGN - Design: Randomized, parallel group Patients: 41,021 patients with AMI, <6h after onset of symptoms Follow up and endpoint: Primary endpoint death at 30 days Treatment: Four thrombolytic strategies compared: Streptokinase (SK) (1.5 million U over 60 min) and SC heparin (12,500 U twice daily) SK (1.5 million U over 60 min) and IV heparin (bolus 5000 U then 1000 U/h) IV t-PA (1 mg/kg over 60 min, 10% bolus) and SK (1 million U over 60 min) and IV heparin (bolus 5000 U then 1000 U/h) Accelerated t-PA (accelerated dose t-PA administered as bolus 15 mg, 0.75 mg/kg over 30 min (max 50 mg) and 0.5 mg/kg over 1h (max 35 mg)) and IV heparin (bolus 5000 U then 1000 U/h)

    3. GUSTO-I: Global Utilization of Streptokinase and t-PA for Occluded coronary arteries - I - RESULTS - Significant reduction in 30-day mortality with accelerated t-PA compared with the streptokinase (SK) and combination strategies No significant difference between combination strategy and the two SK strategies (P=0.352), or between the two SK strategies (P=0.731) Significant excess of hemorrhagic stroke for accelerated t-PA (P=0.03) and combination strategy (P<0.001), compared with the two SK-only strategies However, combined endpoint of death or disabling stroke significantly lower with accelerated t-PA than with SK-only strategies (6.9% versus 7.8%; P=0.006) Do we need anything on subgroups (esp age?) Do we need anything on subgroups (esp age?)

    4. GUSTO-I: Global Utilization of Streptokinase and t-PA for Occluded coronary arteries - I - RESULTS continued -

    5. GUSTO-I: Global Utilization of Streptokinase and t-PA for Occluded coronary arteries - I - RESULTS continued -

    6. GUSTO-I: Global Utilization of Streptokinase and t-PA for Occluded coronary arteries - I - SUMMARY - Although there was an excess of hemorrhagic stroke with t-PA plus heparin, compared with the other regimens, the combined 30-day endpoint of death or disabling stroke was significantly lower with accelerated t-PA An aggressive thrombolytic strategy using accelerated t-PA (over 1.5 hours instead of 3 hours) with heparin, to produce earlier and sustained reperfusion, improves survival significantly compared with standard thrombolytic regimens comprising SK plus heparin

More Related