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GUSTO-I
About the Trial
GUSTO-I randomized 41,021 heart attack patients to four thrombolytic strategies. Accelerated tissue plasminogen activator with heparin reduced 30 day mortality to 6.3 percent versus 7.3 percent with streptokinase, saving about 10 lives per 1,000 treated at the cost of slightly more strokes. It was one of the largest thrombolysis trials ever and confirmed open artery theory: faster, more complete clot lysis saves muscle. Accelerated tPA was widely adopted where affordable. The trial showed meticulous angiographic substudies could explain mechanisms, linking TIMI 3 flow to survival, and set the stage for primary angioplasty to later replace drugs.
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