HOLDING GUSTO UP TO THE LIGHT

被引:39
作者
LEE, KL
CALIFF, RM
SIMES, J
VANDEWERF, F
TOPOL, EJ
机构
[1] UNIV SYDNEY, CTR NHMRC CLIN TRIALS, SYDNEY, NSW 2006, AUSTRALIA
[2] UNIV ZIEKENHUIZEN LEUVEN, UZ GASTHUISBERG, B-3000 LOUVAIN, BELGIUM
[3] CLEVELAND CLIN FDN, CLEVELAND, OH 44195 USA
关键词
D O I
10.7326/0003-4819-120-10-199405150-00009
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO) trial, a recent randomized ''megatrial'' of thrombolytic therapies in acute myocardial infarction, showed a statistically significant decrease of 30-day mortality in patients treated with accelerated-dose tissue plasminogen activator (tPA) compared with streptokinase. The therapeutic and cost implications of the results have been intensely scrutinized, and several commentaries have been written on the interpretation of the study. Questions have been raised about the treatment benefit in certain subgroups, the validity of the results because of the open-label design, the relevance of a 1% absolute benefit in mortality rates, the cost-effectiveness of the drug, and the generalizability of the results. These issues are all important considerations for translating the results of this study into clinical practice worldwide. This article sheds additional light on the interpretation of GUSTO, clarifies misconceptions that may have clouded understanding of the trial results, and discusses the contributions of this trial in advancing our understanding of modern myocardial reperfusion therapy.
引用
收藏
页码:876 / 881
页数:6
相关论文
共 22 条
[1]  
[Anonymous], 1990, LANCET, V336, P65
[2]  
[Anonymous], 1988, LANCET, V2, P349
[3]  
[Anonymous], 1986, LANCET, V1, P397
[4]   INDICATIONS FOR FIBRINOLYTIC THERAPY IN SUSPECTED ACUTE MYOCARDIAL-INFARCTION - COLLABORATIVE OVERVIEW OF EARLY MORTALITY AND MAJOR MORBIDITY RESULTS FROM ALL RANDOMIZED TRIALS OF MORE THAN 1000 PATIENTS [J].
APPLEBY, P ;
BAIGENT, C ;
COLLINS, R ;
FLATHER, M ;
PARISH, S ;
PETO, R ;
BELL, P ;
HALLS, H ;
MEAD, G ;
DIAZ, R ;
PAOLASSO, E ;
PAVIOTTI, C ;
ROMERO, G ;
CAMPBELL, T ;
OROURKE, MF ;
THOMPSON, P ;
LESAFFRE, E ;
VANDEWERF, F ;
VERSTRAETE, M ;
ARMSTRONG, PW ;
CAIRNS, JA ;
MORAN, C ;
TURPIE, AG ;
YUSUF, S ;
GRANDE, P ;
HEIKKILA, J ;
KALA, R ;
BASSAND, JP ;
BOISSEL, JP ;
BROCHIER, M ;
LEIZOROVICZ, A ;
BRUGGEMANN, T ;
KARSCH, KR ;
KASPER, W ;
LAMMERTS, D ;
NEUHAUS, KL ;
MEYER, J ;
SCHRODER, R ;
VONESSEN, R ;
SARAN, RK ;
ARDISSINO, D ;
BONADUCE, D ;
BRUNELLI, C ;
CERNIGLIARO, C ;
FORESTI, A ;
FRANZOSI, MG ;
GUIDUCCI, D ;
MAGGIONI, A ;
MAGNANI, B ;
MATTIOLI, G .
LANCET, 1994, 343 (8893) :311-322
[5]   COMPARATIVE CASE FATALITY ANALYSIS OF THE INTERNATIONAL TISSUE PLASMINOGEN-ACTIVATOR STREPTOKINASE MORTALITY TRIAL - VARIATION BY COUNTRY BEYOND PREDICTIVE PROFILE [J].
BARBASH, GI ;
MODAN, M ;
GOLDBOURT, U ;
WHITE, HD ;
VANDEWERF, F .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1993, 21 (02) :281-286
[6]   MYOCARDIAL-INFARCTION, THROMBOLYTIC THERAPY, AND ECONOMICS [J].
CONTI, CR .
CLINICAL CARDIOLOGY, 1993, 16 (09) :635-635
[7]   CORONARY THROMBOLYSIS - A PERSPECTIVE FOR THE PRACTICING PHYSICIAN [J].
FUSTER, V .
NEW ENGLAND JOURNAL OF MEDICINE, 1993, 329 (10) :723-725
[8]  
HUNT D, 1992, LANCET, V339, P753
[9]   DISCRETE SEQUENTIAL BOUNDARIES FOR CLINICAL-TRIALS [J].
LAN, KKG ;
DEMETS, DL .
BIOMETRIKA, 1983, 70 (03) :659-663
[10]   CLINICAL JUDGMENT AND STATISTICS - LESSONS FROM A SIMULATED RANDOMIZED TRIAL IN CORONARY-ARTERY DISEASE [J].
LEE, KL ;
MCNEER, JF ;
STARMER, CF ;
HARRIS, PJ ;
ROSATI, RA .
CIRCULATION, 1980, 61 (03) :508-515