SELECTION OF THROMBOLYTIC THERAPY FOR INDIVIDUAL PATIENTS - DEVELOPMENT OF A CLINICAL-MODEL

We developed a logistic regression model with data from the GUSTO-I tr ial to predict mortality rate differences in individual patients who r eceived accelerated tissue plasminogen activator (TPA) versus streptok inase treatment for acute myocardial infarction, A nomogram was develo ped from a reduced version of this model that approximated the underly ing risk of patients treated with streptokinase, and thus the benefit of TPA, The 30-day mortality rate with accelerated TPA was 0.063 versu s 0.073 with streptokinase and subcutaneously administered heparin and 0.074 with streptokinase and intravenously administered heparin. No b aseline patient characteristics were significantly associated with a d ifferent relative effect of TPA, Older patients and those with anterio r infarction, higher Killip classification (except Killip class IV), l ower blood pressure, and increased heart rate had the greatest absolut e benefit with accelerated TPA, Patients with acute myocardial infarct ion who had more high-risk characteristics derived a greater absolute benefit from treatment with accelerated TPA versus streptokinase.