Link between the angiographic substudy and mortality outcomes in a large randomized trial of myocardial reperfusion : importance of early and complete infarct artery reperfusion

摘要: Background The Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries (GUSTO-I) trial was designed to test whether thrombolytic strategies achieving more complete, early, sustained coronary artery patency would lead further reductions in mortality patients with acute myocardial infarction. An angiographic substudy within GUSTO-I provided a unique opportunity examine the relation between degrees among regimens. Methods Results Four were compared 41 021 GUSTO-I: streptokinase subcutaneous or intravenous heparin, accelerated tissue plasminogen activator (TPA) combination plus heparin. Accelerated associated lower 30-day (6.3%) than other (7.2%, 7.4%, 7.0%, respectively). Among 1210 randomized angiography 90 minutes after starting treatment, there improved patency, particularly Thrombolysis Myocardial Infarction (TIMI) grade 3 flow, over regimens ( P <.0001). perfusion (TIMI 3) at also significant predictor survival <.01). To determine differences four matched 90-minute model developed predicting main from substudy. assumed that any treatment effects on mediated through treatments. predicted rates then observed remaining each group. treatments 7.46% versus 7.28%; 7.26% 7.39%; TPA, 6.31% 6.37%; 6.98% 6.96%. correlation results .97, proportion squared error explained R 2) .92. Conclusions close supports concept an important mechanism therapy is achievement complete perfusion. match provides strong biological explanation seen sound rationale additional advantage regimen. Irrespective which used, early restoration infarct represents essential goal reperfusion therapy.