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One-year results from the Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries (GUSTO-I) trial. GUSTO-I Investigators.

Publication ,  Journal Article
Califf, RM; White, HD; Van de Werf, F; Sadowski, Z; Armstrong, PW; Vahanian, A; Simoons, ML; Simes, RJ; Lee, KL; Topol, EJ
Published in: Circulation
September 15, 1996

BACKGROUND: In the randomized Global Utilization of t-PA and Streptokinase for Occluded Coronary Arteries (GUSTO-I) trial, 41021 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.

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Published In

Circulation

DOI

ISSN

0009-7322

Publication Date

September 15, 1996

Volume

94

Issue

6

Start / End Page

1233 / 1238

Location

United States

Related Subject Headings

  • Tissue Plasminogen Activator
  • Survival Analysis
  • Streptokinase
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Injections, Subcutaneous
  • Injections, Intravenous
  • Humans
  • Heparin
 

Citation

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Califf, R. M., White, H. D., Van de Werf, F., Sadowski, Z., Armstrong, P. W., Vahanian, A., … Topol, E. J. (1996). One-year results from the Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries (GUSTO-I) trial. GUSTO-I Investigators. Circulation, 94(6), 1233–1238. https://doi.org/10.1161/01.cir.94.6.1233
Califf, R. M., H. D. White, F. Van de Werf, Z. Sadowski, P. W. Armstrong, A. Vahanian, M. L. Simoons, R. J. Simes, K. L. Lee, and E. J. Topol. “One-year results from the Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries (GUSTO-I) trial. GUSTO-I Investigators.Circulation 94, no. 6 (September 15, 1996): 1233–38. https://doi.org/10.1161/01.cir.94.6.1233.
Califf RM, White HD, Van de Werf F, Sadowski Z, Armstrong PW, Vahanian A, et al. One-year results from the Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries (GUSTO-I) trial. GUSTO-I Investigators. Circulation. 1996 Sep 15;94(6):1233–8.
Califf, R. M., et al. “One-year results from the Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries (GUSTO-I) trial. GUSTO-I Investigators.Circulation, vol. 94, no. 6, Sept. 1996, pp. 1233–38. Pubmed, doi:10.1161/01.cir.94.6.1233.
Califf RM, White HD, Van de Werf F, Sadowski Z, Armstrong PW, Vahanian A, Simoons ML, Simes RJ, Lee KL, Topol EJ. One-year results from the Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries (GUSTO-I) trial. GUSTO-I Investigators. Circulation. 1996 Sep 15;94(6):1233–1238.

Published In

Circulation

DOI

ISSN

0009-7322

Publication Date

September 15, 1996

Volume

94

Issue

6

Start / End Page

1233 / 1238

Location

United States

Related Subject Headings

  • Tissue Plasminogen Activator
  • Survival Analysis
  • Streptokinase
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Injections, Subcutaneous
  • Injections, Intravenous
  • Humans
  • Heparin