TY - JOUR
T1 - Survival outcomes 1 year after reperfusion therapy with either alteplase or reteplase for acute myocardial infarction
T2 - Results from the global utilization of streptokinase and t-PA for occluded coronary arteries (GUSTO) III trial
AU - Topol, Eric J.
AU - Ohman, E. Magnus
AU - Armstrong, Paul W.
AU - Wilcox, Robert
AU - Skene, Alan M.
AU - Aylward, Philip
AU - Simes, John
AU - Dalby, Anthony
AU - Betriu, Amadeo
AU - Bode, Christoph
AU - White, Harvey D.
AU - Hochman, Judith S.
AU - Emanuelson, Hakan
AU - Vahanian, Alec
AU - Sapp, Shelly
AU - Stebbins, Amanda
AU - Moliterno, David J.
AU - Califf, Robert M.
PY - 2000/10/10
Y1 - 2000/10/10
N2 - Background - New recombinant plasminogen activators have been developed to simulate the fibrinolytic action of the physiological serine protease tissue plasminogen activator (alteplase, t-PA), and have prolonged half-life features permitting bolus administration. One such activator, reteplase (r-PA), was compared with t-PA in the Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO)-III Trial. Methods and Results - At 1-year follow-up, survival status was ascertained in 97.4% of the 15 059 patients enrolled in the GUSTO-III trial. At 1 year, the mortality rate for the t-PA-assigned group was 11.06%, and for r-PA it was 11.20% (P=0.77). The absolute mortality difference of 0.14% has 95% CIs of -1.21% to 0.93%. There were no significant differences in outcome by intention-to-treat for the 2 different plasminogen activators in the prespecified groups (age, infarct location, time-to-treatment). The absolute difference in mortality rates between t-PA and r-PA progressively narrowed over the predetermined observation times after random assignment; it was 0.31% at 24 hours, 0.26% at 7 days, 0.23% at 30 days, and 0.14% at 1 year. Of note, mortality rate in the trial between 30 days and 1 year in 13 883 patients was 4.02% and did not differ between the treatment groups. However, this mortality rate was substantially greater than in GUSTO-I, in which mortality rate for t-PA versus streptokinase between 30 days and 1-year was 2.97% (heart rate 1.36, 95% CI 1.23, 1.50, P<0.001). Conclusions - The r-PA and t-PA strategies yielded similar survival outcomes after 30 days in this trial. The increase in mortality rate during extended follow-up compared with previous trials may reflect higher-risk patients and highlights the need for improved secondary prevention strategies.
AB - Background - New recombinant plasminogen activators have been developed to simulate the fibrinolytic action of the physiological serine protease tissue plasminogen activator (alteplase, t-PA), and have prolonged half-life features permitting bolus administration. One such activator, reteplase (r-PA), was compared with t-PA in the Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO)-III Trial. Methods and Results - At 1-year follow-up, survival status was ascertained in 97.4% of the 15 059 patients enrolled in the GUSTO-III trial. At 1 year, the mortality rate for the t-PA-assigned group was 11.06%, and for r-PA it was 11.20% (P=0.77). The absolute mortality difference of 0.14% has 95% CIs of -1.21% to 0.93%. There were no significant differences in outcome by intention-to-treat for the 2 different plasminogen activators in the prespecified groups (age, infarct location, time-to-treatment). The absolute difference in mortality rates between t-PA and r-PA progressively narrowed over the predetermined observation times after random assignment; it was 0.31% at 24 hours, 0.26% at 7 days, 0.23% at 30 days, and 0.14% at 1 year. Of note, mortality rate in the trial between 30 days and 1 year in 13 883 patients was 4.02% and did not differ between the treatment groups. However, this mortality rate was substantially greater than in GUSTO-I, in which mortality rate for t-PA versus streptokinase between 30 days and 1-year was 2.97% (heart rate 1.36, 95% CI 1.23, 1.50, P<0.001). Conclusions - The r-PA and t-PA strategies yielded similar survival outcomes after 30 days in this trial. The increase in mortality rate during extended follow-up compared with previous trials may reflect higher-risk patients and highlights the need for improved secondary prevention strategies.
KW - Myocardial infarction
KW - Plasminogen activators
KW - Reperfusion
UR - http://www.scopus.com/inward/record.url?scp=0034633819&partnerID=8YFLogxK
U2 - 10.1161/01.CIR.102.15.1761
DO - 10.1161/01.CIR.102.15.1761
M3 - Article
C2 - 11023929
AN - SCOPUS:0034633819
SN - 0009-7322
VL - 102
SP - 1761
EP - 1765
JO - Circulation
JF - Circulation
IS - 15
ER -