CHAPTER 23 tPA in Acute MI: The Gusto Trial

An International Randomized Trial Comparing Four Thrombolytic Strategies for Acute Myocardial Infarction. The Gusto Investigators

N Engl J Med. 1993;329(10):673–682

BACKGROUND

Although the ISIS-2 showed a survival benefit for streptokinase in acute MI in 1988, there had been no subsequent studies confirming additional benefit with other fibrinolytic therapies for acute MI. There had been studies showing no difference in associated mortality between the use of streptokinase and the use of tissue plasminogen activator (tPA) in acute MI but no research into the timing of thrombolytics and the combination of thrombolytics with heparin.

OBJECTIVES

To compare the effects of four thrombolytic strategies on mortality: Streptokinase with subcutaneous heparin, streptokinase with IV heparin, accelerated tPA with IV heparin, and streptokinase with tPA and IV heparin.

METHODS

Randomized prospective trial in 1,081 hospitals in 15 countries between 1990 and 1993.

Patients

41,021 patients with AMI who presented between 20 minutes and 6 hours of symptom onset and with ischemic EKG changes. Select exclusion criteria: Previous stroke, active bleeding, prior treatment with streptokinase or anistreplase, recent trauma, or major surgery.

Intervention Evaluated

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