EBM Consult

GUSTO-III (1 Year) Global Utilization of Streptokinase and tPA for Occluded Coronary Arteries-III

  • This is the 1-year follow up survival analysis from patients enrolled into the GUSTO-III trial.
  • The 1-year survival was similar for patients presenting with acute myocardial infarction (AMI) and received either alteplase or reteplase. 
  • Mortality rate after 30 days in GUSTO-1 was 2.97%; in this study it was 4.02% (p<0.001). This difference may have been related to higher risk patients (older, anterior MI, higher blood pressure, more females)

GUSTO-III (1-Year) Analysis

  • Topol EJ, et al. Survival outcome 1 year after reperfusion therapy with either alteplase or reteplase for acute myocardial infarction. Results from the global utilization of streptokinase and tPA for occluded coronary arteries (GUSTO) trial. Circulation 2000;102:1761-1765. PubMed
    Study Design Prospective, randomized, multicenter, comparative trial
    Sample Size n = 14,674 patients with acute MI
    Treatment Arms
      • n = 4789 tPa (alteplase) 100 mg IV over 90 minutes 
      • n = 9885 given rPA (reteplase) 20 MU IV given as 2 boluses of 10 MU 30 minutes apart
      Primary Endpoint 1-year outcome of myocardial infarct treated with tPA (alteplase) vs rPA (reteplase) and to compare outcomes at 30 days and with previous GUSTO-1 trial.
      Follow Up 1-Year
      Results
      • 1-year mortality rate for alteplase was 11.06%, for reteplase it was 11.20% (p=0.77).
      • Absolute mortality difference of 0.14% (NS).
      • No treatment differences in pre-specified groups: by age, infarct location, and time-to-treatment. For survivors at 30 days, the 1-year mortality rates were 4.07% in the tPA group vs 3.99% in rPA group (p=0.81).
      Conclusion For acute MI, alteplase and reteplase had similar 1-year survival.
      Comments Mortality rate after 30 days in GUSTO-1 was 2.97%; in this study it was 4.02% (p<0.001). This difference may have been related to higher risk patients (older, anterior MI, higher blood pressure, more females) in GUSTO-II vs GUSTO01.