ONE-YEAR RESULTS FROM THE GLOBAL UTILIZATION OF STREPTOKINASE AND TPAFOR OCCLUDED CORONARY-ARTERIES (GUSTO-I) TRIAL

Background In the randomized Global Utilization of t-PA and Streptokin ase for Occluded Coronary Arteries (GUSTO-I) trial, 41 021 patients re ceived one of four thrombolytic regimens. Patients treated with accele rated 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 s pecified at randomization) was contacted by telephone. A locator servi ce was used in the United States for patients who could not be located by these methods. Final follow-up was 96% worldwide. One-year mortali ty rates remained in favor of accelerated TPA (9.1%) over streptokinas e with subcutaneous heparin (10.1%, P=.011) and streptokinase with int ravenous heparin (10.1%, P=.009). Combination therapy had an intermedi ate 1-year mortality (9.9%); this outcome was statistically indistingu ishable from that with streptokinase (P=.47) but was marginally differ ent from that with accelerated TPA (P=.05). Conclusions The 1-year res ults demonstrated a saving of 10 lives per 1000 patients treated with accelerated TPA versus streptokinase and subcutaneous or intravenous h eparin. Combination thrombolytic therapy had an intermediate benefit b ut offered no advantage over accelerated TPA treatment alone.