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(Circulation. 1996;94:1203-1205.)
© 1996 American Heart Association, Inc.

Articles

La Difference

Long-term Benefit of One Thrombolytic Over Another

Robert Roberts, MD

the Bugher Foundation for Molecular Biology, Baylor College of Medicine, Houston, Tex.

Correspondence to Robert Roberts, MD, Section of Cardiology, Baylor College of Medicine, 6550 Fannin, MS SM677, Houston TX 77030.

Key Words: Editorials • myocardial infarction • thrombolysis • thrombosis • prognosis

	Introduction

 
Recanalization of coronary arteries, induced by either thrombolytic therapy or angioplasty, has revolutionized the management of acute myocardial infarction. The mean in-hospital death rate for patients who reach the hospital in time and receive thrombolytic therapy is 6% to 7%.¹ This is a dramatic reduction compared with the death rate in the 1960s of 30% to 35%. Thrombolytic therapy is easy to administer and is carried out routinely in community hospitals throughout North America and many other parts of the world. In addition to the reduced death rate, there is likely to be a reduced morbidity; however, this is more difficult to prove. Clinical trials to date on thrombolytics have concentrated on mortality, in part because this is the major, if not the sole, end point required by the Food and Drug Administration to approve a new drug.

In the original Global Utilization of t-PA and Streptokinase for Occluded Coronary Arteries (GUSTO-I) trial,¹ the 41 021 patients who were enrolled received one of four thrombolytic agents. Patients who had ST-segment elevation and presented within 6 hours of onset were enrolled unless there was a contraindication. Enrollment had no age limit and included patients in cardiogenic shock and those with previous bypass surgery; thus, this population was highly representative of the patient population at large presenting with acute myocardial infarction.

The overall objective of GUSTO-I was to compare four thrombolytic regimens: streptokinase followed by subcutaneous heparin, streptokinase followed by intravenous heparin, tissue plasminogen activator (TPA*) 100 mg given over 60 minutes . . . [Full Text of this Article]