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1、GUSTO-I:GlobalUtilizationofStreptokinaseand t-PAforOccludedcoronaryarteries-IPurposeTocompareanaggressivethrombolyticstrategyusingacceleratedtissueplasminogenactivator(t-PA)withstandardthrombolyticstrategiesinthetreatmentofacutemyocardialinfarctionReferenceTheGUSTOInvestigators.An
2、internationalrandomizedtrialcomparingfourthrombolyticstrategiesforacutemyocardial infarction.NEnglJMed1993;329:673-82.GUSTO-I:GlobalUtilizationofStreptokinaseand t-PAforOccludedcoronaryarteries-I-TRIALDESIGN-Design:Randomized,parallelgroupPatients:41,021patientswithAMI,<6hafterons
3、etofsymptomsFollowupandendpoint:Primaryendpointdeathat30daysTreatment:Fourthrombolyticstrategiescompared:Streptokinase(SK)(1.5millionUover60min)andSCheparin(12,500Utwicedaily)SK(1.5millionUover60min)andIVheparin(bolus5000Uthen1000U/h)IVt-PA(1mg/kgover60min,10%bolus)andSK(1millionU
4、over60min)andIVheparin(bolus5000Uthen1000U/h)Acceleratedt-PA(accelerateddoset-PAadministeredasbolus15mg,0.75mg/kgover30min(max50mg)and0.5mg/kg over1h(max35mg))andIVheparin(bolus5000Uthen 1000U/h)GUSTO-I:GlobalUtilizationofStreptokinaseand t-PAforOccludedcoronaryarteries-I-RESULTS-
5、Significantreductionin30-daymortalitywithacceleratedt-PAcomparedwiththestreptokinase(SK)andcombinationstrategiesNosignificantdifferencebetweencombinationstrategyandthetwoSKstrategies(P=0.352),orbetweenthetwoSKstrategies(P=0.731)Significantexcessofhemorrhagicstrokeforacceleratedt-P
6、A(P=0.03)andcombinationstrategy(P<0.001),comparedwiththetwoSK-onlystrategiesHowever,combinedendpointofdeathordisablingstrokesignificantlylowerwithacceleratedt-PAthanwithSK-onlystrategies(6.9%versus7.8%;P=0.006)GUSTO-I:GlobalUtilizationofStreptokinaseand t-PAforOccludedcoronaryarte
7、ries-I-RESULTScontinued-TheGUSTOInvestigators.NEnglJMed1993;329:673–82.Thirty-daymortalityandstrokeinthefourtreatmentgroupsDaysafterrandomization001020302648SK+IVheparinSK+SCheparint-PA+SK+IVheparinAcceleratedt-PAMortality(%)GUSTO-I:GlobalUtilizationofStreptokinaseand t-PAforOcclu
8、dedcoronaryarteries-I-RESULTScont
