Selection of thrombolytic therapy for individual patients: development of a clinical model. GUSTO-I Investigators.

Califf RM, Woodlief LH, Harrell FE, Lee KL, White HD, Guerci A, Barbash GI, Simes RJ, Weaver WD, Simoons ML, Topol EJ
Am Heart J. 1997 133 (6): 630-9

PMID: 9200390 · DOI:10.1016/s0002-8703(97)70164-9

We developed a logistic regression model with data from the GUSTO-I trial to predict mortality rate differences in individual patients who received accelerated tissue plasminogen activator (TPA) versus streptokinase treatment for acute myocardial infarction. A nomogram was developed from a reduced version of this model that approximated the underlying risk of patients treated with streptokinase, and thus the benefit of TPA. The 30-day mortality rate with accelerated TPA was 0.063 versus 0.073 with streptokinase and subcutaneously administered heparin and 0.074 with streptokinase and intravenously administered heparin. No baseline patient characteristics were significantly associated with a different relative effect of TPA. Older patients and those with anterior infarction, higher Killip classification (except Killip class IV), lower blood pressure, and increased heart rate had the greatest absolute benefit with accelerated TPA. Patients with acute myocardial infarction who had more high-risk characteristics derived a greater absolute benefit from treatment with accelerated TPA versus streptokinase.

MeSH Terms (23)

Aged Age Factors Anticoagulants Blood Pressure Fibrinolytic Agents Forecasting Heart Rate Heparin Humans Injections, Intravenous Injections, Subcutaneous Logistic Models Middle Aged Models, Statistical Myocardial Infarction Plasminogen Activators Prognosis Risk Factors Streptokinase Survival Rate Thrombolytic Therapy Tissue Plasminogen Activator Treatment Outcome

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