TY - JOUR
T1 - Mortality at 1 year with combination platelet glycoprotein IIb/IIIa inhibition and reduced-dose fibrinolytic therapy vs conventional fibrinolytic therapy for acute myocardial infarction
T2 - GUSTO V randomized trial
AU - Michael Lincoff, A.
AU - Califf, Robert M.
AU - De Van Werf, Frans
AU - Willerson, James T.
AU - White, Harvey D.
AU - Armstrong, Paul W.
AU - Guetta, Victor
AU - Brian Gibler, W.
AU - Hochman, Judith S.
AU - Bode, Christoph
AU - Vahanian, Alec
AU - Gabriel Steg, P.
AU - Ardissino, Diego
AU - Savonitto, Stefano
AU - Bar, Frits
AU - Sadowski, Zygmunt
AU - Betriu, Amadeo
AU - Booth, Joan E.
AU - Wolski, Kathy
AU - Waller, Michael
AU - Topol, Eric J.
PY - 2002/11/6
Y1 - 2002/11/6
N2 - Context: Among patients with acute myocardial infarction, combination reperfusion therapy with a platelet glycoprotein IIb/IIIa receptor inhibitor (abciximab) and a half dose of a plasminogen activator (reteplase) did not significantly reduce mortality at 30 days compared with a full dose of reteplase. Rates of nonfatal ischemic complications were significantly diminished. Objective: To determine if the beneficial effects of abciximab and reteplase (combination therapy) on early nonfatal complications would translate into a reduction in the risk of death by 1 year. Design, Setting, and Patients: One-year follow-up of a randomized controlled trial (Global Use of Strategies To Open Coronary Arteries [GUSTO] V). Of 16588 patients who had been treated in 820 community and referral hospitals in 20 countries between July 1999 and February 2001, mortality data were available for 16453 (99.2%). Intervention: Patients were randomly assigned to receive (intravenously) a standard dose of reteplase (two 10-U boluses, 30 minutes apart) or the combination of a standard dose of abciximab (0.25 mg/kg bolus, 0.125 pg/kg per minute infusion [maximum 10 μg/min for 12 hours]) and a half dose of reteplase (two 5-U boluses, 30 minutes apart). Main Outcome Measure: One-year all-cause mortality rates. Results: All-cause mortality at 1 year occurred in 692 (8.38%) of 8260 patients in the reteplase group and 698 (8.38%) of the 8328 patients in the combination therapy group (hazard ratio [HR], 1.00; 95% confidence interval [CII, 0.90-1.11; P>.99). Reinfarction within the first 7 days occurred in 3.5% of patients in the reteplase group and 2.3% of patients in the combination therapy group, and was significantly associated with 1 -year mortality (22.6% in patients with reinfarction vs 8.0% in patients without reinfarction; HR, 3.08; 95% CI, 2.53-3.75; P<.001). However, treatment assignment did not significantly influence time of mortality regardless of reinfarction status. Conclusion: Combination therapy (abciximab and reteplase) did not reduce mortality over 1 year compared with fibrinolytic therapy with reteplase alone.
AB - Context: Among patients with acute myocardial infarction, combination reperfusion therapy with a platelet glycoprotein IIb/IIIa receptor inhibitor (abciximab) and a half dose of a plasminogen activator (reteplase) did not significantly reduce mortality at 30 days compared with a full dose of reteplase. Rates of nonfatal ischemic complications were significantly diminished. Objective: To determine if the beneficial effects of abciximab and reteplase (combination therapy) on early nonfatal complications would translate into a reduction in the risk of death by 1 year. Design, Setting, and Patients: One-year follow-up of a randomized controlled trial (Global Use of Strategies To Open Coronary Arteries [GUSTO] V). Of 16588 patients who had been treated in 820 community and referral hospitals in 20 countries between July 1999 and February 2001, mortality data were available for 16453 (99.2%). Intervention: Patients were randomly assigned to receive (intravenously) a standard dose of reteplase (two 10-U boluses, 30 minutes apart) or the combination of a standard dose of abciximab (0.25 mg/kg bolus, 0.125 pg/kg per minute infusion [maximum 10 μg/min for 12 hours]) and a half dose of reteplase (two 5-U boluses, 30 minutes apart). Main Outcome Measure: One-year all-cause mortality rates. Results: All-cause mortality at 1 year occurred in 692 (8.38%) of 8260 patients in the reteplase group and 698 (8.38%) of the 8328 patients in the combination therapy group (hazard ratio [HR], 1.00; 95% confidence interval [CII, 0.90-1.11; P>.99). Reinfarction within the first 7 days occurred in 3.5% of patients in the reteplase group and 2.3% of patients in the combination therapy group, and was significantly associated with 1 -year mortality (22.6% in patients with reinfarction vs 8.0% in patients without reinfarction; HR, 3.08; 95% CI, 2.53-3.75; P<.001). However, treatment assignment did not significantly influence time of mortality regardless of reinfarction status. Conclusion: Combination therapy (abciximab and reteplase) did not reduce mortality over 1 year compared with fibrinolytic therapy with reteplase alone.
UR - http://www.scopus.com/inward/record.url?scp=0037032380&partnerID=8YFLogxK
U2 - 10.1001/jama.288.17.2130
DO - 10.1001/jama.288.17.2130
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C2 - 12413372
AN - SCOPUS:0037032380
VL - 288
SP - 2130
EP - 2135
JO - JAMA - Journal of the American Medical Association
JF - JAMA - Journal of the American Medical Association
SN - 0002-9955
IS - 17
ER -