MORTALITY-RATES WITH SARUPLASE

Thrombolytic therapy has contributed to the decline in hospital mortal ity following myocardial infarction. Measurement of mortality rates is appealing, due to the ease of documentation. The GUSTO study, which c ompared alteplase and streptokinase regimens, demonstrated that higher patency rates result in lower 30-day mortality. Saruplase is more eff icacious than streptokinase at restoring coronary artery patency. Pate ncy at 60 min after starting saruplase was 71.8% and after streptokina se 48.0%, in the PRIMI study. Therefore, the COMPASS study was perform ed to compare the 30-day mortality rates of saruplase and streptokinas e, and 3089 patients were entered into the study in 104 centres. The m ortality rates at 30 days were 5.7% for saruplase and 6.7% for strepto kinase, a 15% relative reduction. The odds ratio was 0.84 (p<0.01 for equivalence). Therefore, saruplase can be considered to be at least cl inically equivalent to streptokinase in terms of mortality. Stroke rat es were 1.4% in both groups, and there was no difference in the rate o f bleeding events. Reinfarction occurred in 5.4% of the saruplase-trea ted patients and in 4.5% of the streptokinase-treated patients. Hypote nsion and cardiogenic shock were reported more often following treatme nt with streptokinase than following treatment with saruplase.