Does tissue-type plasminogen activator improve clinical outcomes compared to streptokinase in patients with acute myocardial infarction?
Bayesian analysis provides a formal method to evaluate the probability of a clinically meaningful difference, demonstrating that the superiority of tPA over streptokinase in the GUSTO trial remains uncertain.
Standard statistical analyses of randomized clinical trials fail to provide a direct assessment of which treatment is superior or the probability of a clinically meaningful difference. A Bayesian analysis permits the calculation of the probability that a treatment is superior based on the observed data and prior beliefs. The subjectivity of prior beliefs in the Bayesian approach is not a liability, but rather explicitly allows different opinions to be formally expressed and evaluated. The usefulness of this approach is demonstrated using the results of the recent GUSTO study of various thrombolytic strategies in acute myocardial infarction. This analysis suggests that the clinical superiority of tissue-type plasminogen activator over streptokinase remains uncertain.
James M. Brophy (Wed,) studied this question.