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June 1, 1994

Cardiovascular Disease

Author Affiliations

University of Massachusetts Medical School, Worcester; University of Arizona Health Sciences Center, Tucson

JAMA. 1994;271(21):1660-1661. doi:10.1001/jama.1994.03510450032017

No one can dispute that thrombolytic therapy saves lives. However, the question remains, which is the most cost-effective agent: streptokinase (SK) or tissue-type plasminogen activator (t-PA)? Several studies have suggested that t-PA is more effective than SK; however, given the fact that t-PA is nearly 10 times as expensive as SK, further clinical trials were performed to verify that t-PA is more effective. The results of the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO) study, which were reported in the fall of 1993,1,2 strongly suggest that t-PA is more effective than SK. The GUSTO study enrolled 41 021 patients from 1081 hospitals in 15 countries and compared the following four treatment strategies for acute myocardial infarction (AMI): (1) SK plus subcutaneous heparin; (2) SK plus intravenous (IV) heparin; (3) combined t-PA, SK, and IV heparin; and (4) accelerated t-PA (administration of t-PA over

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