The GUSTO trial: background and baseline characteristics.

The GUSTO study was designed to test the hypothesis that achieving early sustained patency with a thrombolytic regimen in acute coronary thrombosis would improve mortality. Four regimens were compared. In 41,021 patients randomised, nearly 3000 of these were in Australia and New Zealand. These regimens were streptokinase (SK) with subcutaneous heparin (9841 patients), SK and intravenous heparin (10,410 patients), accelerated tissue plasminogen activator (t-PA) and intravenous heparin (10,396 patients) and combined SK and t-PA (10,374 patients). The patients were well matched for baseline characteristics. The mean time to treatment was two hours. The accompanying regimen of investigation and revascularisation was aggressive--58% receiving angiography (28% in Australia), 15% angioplasty (5% in Australia) and 9% bypass surgery (4% in Australia). The GUSTO trial results should be interpreted in the light of these background observations.