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Selection of thrombolytic therapy for individual patients: development of a clinical model. GUSTO-I Investigators.

Publication ,  Journal Article
Califf, RM; Woodlief, LH; Harrell, FE; Lee, KL; White, HD; Guerci, A; Barbash, GI; Simes, RJ; Weaver, WD; Simoons, ML; Topol, EJ
Published in: Am Heart J
June 1997

We developed a logistic regression model with data from the GUSTO-I trial to predict mortality rate differences in individual patients who received accelerated tissue plasminogen activator (TPA) versus streptokinase treatment for acute myocardial infarction. A nomogram was developed from a reduced version of this model that approximated the underlying risk of patients treated with streptokinase, and thus the benefit of TPA. The 30-day mortality rate with accelerated TPA was 0.063 versus 0.073 with streptokinase and subcutaneously administered heparin and 0.074 with streptokinase and intravenously administered heparin. No baseline patient characteristics were significantly associated with a different relative effect of TPA. Older patients and those with anterior infarction, higher Killip classification (except Killip class IV), lower blood pressure, and increased heart rate had the greatest absolute benefit with accelerated TPA. Patients with acute myocardial infarction who had more high-risk characteristics derived a greater absolute benefit from treatment with accelerated TPA versus streptokinase.

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Published In

Am Heart J

DOI

ISSN

0002-8703

Publication Date

June 1997

Volume

133

Issue

6

Start / End Page

630 / 639

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tissue Plasminogen Activator
  • Thrombolytic Therapy
  • Survival Rate
  • Streptokinase
  • Risk Factors
  • Prognosis
  • Plasminogen Activators
  • Myocardial Infarction
  • Models, Statistical
 

Citation

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Califf, R. M., Woodlief, L. H., Harrell, F. E., Lee, K. L., White, H. D., Guerci, A., … Topol, E. J. (1997). Selection of thrombolytic therapy for individual patients: development of a clinical model. GUSTO-I Investigators. Am Heart J, 133(6), 630–639. https://doi.org/10.1016/s0002-8703(97)70164-9
Califf, R. M., L. H. Woodlief, F. E. Harrell, K. L. Lee, H. D. White, A. Guerci, G. I. Barbash, et al. “Selection of thrombolytic therapy for individual patients: development of a clinical model. GUSTO-I Investigators.Am Heart J 133, no. 6 (June 1997): 630–39. https://doi.org/10.1016/s0002-8703(97)70164-9.
Califf RM, Woodlief LH, Harrell FE, Lee KL, White HD, Guerci A, et al. Selection of thrombolytic therapy for individual patients: development of a clinical model. GUSTO-I Investigators. Am Heart J. 1997 Jun;133(6):630–9.
Califf, R. M., et al. “Selection of thrombolytic therapy for individual patients: development of a clinical model. GUSTO-I Investigators.Am Heart J, vol. 133, no. 6, June 1997, pp. 630–39. Pubmed, doi:10.1016/s0002-8703(97)70164-9.
Califf RM, Woodlief LH, Harrell FE, Lee KL, White HD, Guerci A, Barbash GI, Simes RJ, Weaver WD, Simoons ML, Topol EJ. Selection of thrombolytic therapy for individual patients: development of a clinical model. GUSTO-I Investigators. Am Heart J. 1997 Jun;133(6):630–639.
Journal cover image

Published In

Am Heart J

DOI

ISSN

0002-8703

Publication Date

June 1997

Volume

133

Issue

6

Start / End Page

630 / 639

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tissue Plasminogen Activator
  • Thrombolytic Therapy
  • Survival Rate
  • Streptokinase
  • Risk Factors
  • Prognosis
  • Plasminogen Activators
  • Myocardial Infarction
  • Models, Statistical