Thrombolytic therapy GUSTO-1 trial

Aylward PE, Wilcox RG, Horgan JH, White HD, Granger CB, Califf RM, Topol EJ. Relation of increased arterial blood pressure to mortahty and stroke in the context of contemporary thrombolytic therapy for acute myocardial infarction. A randomized trial. GUSTO-I Investigators. Ann Intern Med 1996 125(ll) 891-900. 

Figure 1.4 The importance of time to reperfusion for patients with STEMI is a unifying principal of treatment with primary PCI, thrombolytic therapy, or both. Results in GUSTO 11b trial demonstrate an increase in mortality as a function of delay in door to time of primary PCI. (From Ref. 34.)...

Labinaz M, Sketch MH, Ellis SG, et al. for the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries trial (GUSTO-I). Outcome of acute ST-segment elevation myocardial infarction in patients with prior coronary artery bypass surgery receiving thrombolytic therapy. Am Heart J 2001 141 469-477. 

White HD, Barbash GI, Califf RM, Simes RJ, Granger CB, Weaver WD, Kleiman NS, Aylward RP, Gore JM, Vahanian A, Lee KL, Ross AM, Topol EJ. Age and outcome with contemporary thrombolytic therapy. Results from the GUSTO-I trial. Global Utilization of Streptokinase and TPA for Occluded coronary arteries trial. Circulation 1996 94 1826-1833. 

Combination therapy with a thrombolytic agent and GPIIb/llla inhibitor has been studied in acute Ml. Various randomized trials (TAMI-8, IMPACT INTRO AMI, TIMI-14, SPEED, GUSTO V) in the coronary literature have shown that combination therapy reduced thrombolysis time and permitted a reduction of thrombolytic doses by 25% to 50% of the normal dose, This is explained by the fact that thrombus is composed of both fibrin and platelets. Thrombolytics only address the fibrin component of acute thrombus, Furthermore, thrombolytics may actually activate platelets directly resulting in additional thrombus formation, Therefore, the addition of GPIIb/llla inhibition facilitates the efficiency of the thrombolytic agent, It is also known that GPIIb/llla inhibition alone can actually dissolve platelet rich clot (41,42,43),... 

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