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

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

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

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    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