What question did this study set out to answer?

To examine differences in outcomes and patient management for acute myocardial infarction in the US and internationally.

May 24, 1995JAMA

Variations in patient management and outcomes for acute myocardial infarction in the United States and other countries. Results from the GUSTO trial. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries

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Why the study?

Does accelerated rt-PA or combination therapy improve 30-day mortality compared to streptokinase in patients with acute myocardial infarction, and do outcomes and management vary between the US and other countries?

Key Points

To examine differences in outcomes and patient management for acute myocardial infarction in the US and internationally.
Randomized trial involving 23,105 US patients and 17,916 non-US patients.
Patients received either streptokinase with heparin or accelerated rt-PA with heparin.
Logistic regression analyses assessed treatment outcomes and country interactions.
Mortality reduction with accelerated rt-PA in the US was 1.2% versus 0.7% elsewhere (P = .30).
Benefits of accelerated rt-PA over combination therapy were significant in the US (P = .02).
30-day mortality rate was 6.8% in the US versus 7.2% internationally, with no significant difference (P = .09).

Structured PICO

Population

41,021 patients undergoing thrombolysis for acute myocardial infarction (n=23,105 in the United States and n=17,916 in 14 other countries)

Intervention

Accelerated recombinant tissue-type plasminogen activator (rt-PA) plus IV heparin, or combined streptokinase and rt-PA plus IV heparin

Comparator

Streptokinase plus either subcutaneous or intravenous (IV) heparin

Outcome

30-day mortalityhard clinical

Increased procedure and treatment use in the US for acute myocardial infarction was associated with only a marginally significant decrease in short-term mortality compared to other countries.

Limitations

Long-term follow-up is required to clarify the relationship between survival and the more intensive US management approach

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

Consistent mortality and treatment effects across regions support global application of findings; extends thrombolytic trial results beyond US practice.

Cite This Study

Frans Van de Werf (1995) studied this question.

synapsesocial.com/papers/6a0896d2ae7f011b61ddf2e4 https://doi.org/10.1001/jama.273.20.1586

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Implication

Consistent mortality and treatment effects across regions support global application of findings; extends thrombolytic trial results beyond US practice.

Variations in patient management and outcomes for acute myocardial infarction in the United States and other countries. Results from the GUSTO trial. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries

Key Points

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Variations in patient management and outcomes for acute myocardial infarction in the United States and other countries. Results from the GUSTO trial. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries

Key Points

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Also Consider

Also Consider