Mortality at 1 year with combination platelet glycoprotein IIb/IIIa inhibition and reduced-dose fibrinolytic therapy vs conventional fibrinolytic therapy for acute myocardial infarction: GUSTO V randomized trial

A. Michael Lincoff, Robert M. Califf, Frans De Van Werf, James T. Willerson, Harvey D. White, Paul W. Armstrong, Victor Guetta, W. Brian Gibler, Judith S. Hochman, Christoph Bode, Alec Vahanian, P. Gabriel Steg, Diego Ardissino, Stefano Savonitto, Frits Bar, Zygmunt Sadowski, Amadeo Betriu, Joan E. Booth, Kathy Wolski, Michael WallerEric J. Topol

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)2130-2135
Number of pages6
JournalJAMA - Journal of the American Medical Association
Volume288
Issue number17
DOIs
StatePublished - 6 Nov 2002
Externally publishedYes

Fingerprint

Dive into the research topics of 'Mortality at 1 year with combination platelet glycoprotein IIb/IIIa inhibition and reduced-dose fibrinolytic therapy vs conventional fibrinolytic therapy for acute myocardial infarction: GUSTO V randomized trial'. Together they form a unique fingerprint.

Cite this