(Circulation. 1996;94:1-5.)
© 1996 American Heart Association, Inc.
Articles |
Meeting Highlights
American College of Cardiology 45th Annual Scientific Session, Orlando, Florida, March 24 to 27, 1996
St Luke's Episcopal Hospital, Texas Heart Institute, Baylor College of Medicine, University of Texas Health Science Center at Houston.
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GUSTO IIb |
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Dr Frans Van de Werf, from the University Hospital Gasthuisberg in Leuven, Belgium, Drs Robert Califf and Christopher Granger from Duke University, Durham, NC, and Dr Eric Topol, from the Cleveland (Ohio) Clinic, presented the results of the GUSTO IIb study, a large, international, multicenter trial of heparin versus hirudin in patients with acute MI and unstable angina. A total of 12 142 qualifying patients (onset of symptoms within 12 hours and ischemic ECG changes) were stratified into two groups on the basis of whether or not ST-segment elevation was present and randomized to receive heparin or hirudin. The primary end point of the study was the 30-day incidence of death and MI. Because of prior experience with a high level of bleeding complications in GUSTO IIa, the doses of study drug (both heparin and hirudin) used in GUSTO IIb were significantly reduced from GUSTO IIa. Patients treated with hirudin were noted to require fewer adjustments to maintain therapeutic levels (a mean of two adjustments versus four with heparin), and there were more hirudin patients who did not require any dose adjustments (28.5% versus 5.4% with heparin). In the ST-segment elevation group (n=4131), there was marked benefit of hirudin at 24 hours in the incidence of death and MI but no significant differences between the hirudin and heparin groups in terms of severe bleeding events (1.1% with hirudin, 1.5% with heparin), stroke (1.3% with hirudin, 0.8% with heparin), death at 30 days (5.9% versus 6.3%), and reinfarction at 30 days
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