Interpreting Key Trials

Angioplasty or fibrinolysis for acute MI? The GUSTO IIb study

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The angioplasty substudy of the GUSTO llb trial confirmed that the short-term results of primary angioplasty are better than those of fibrinolytic therapy in patients with acute myocardial infarction (Ml). In the largest and most rigorous study of this topic performed to date, 9.6% of patients who underwent primary angioplasty either died or suffered a disabling stroke or another myocardial infarction within 30 days, compared with 13.7% of patients who received fibrinolytic therapy, for an odds ratio of 0.67 (P = .033). This difference was less than in previous studies, possibly in part because fibrinolytic therapy has improved. The findings underscore the importance of promptly restoring complete, brisk, antegrade flow in the infarct-related artery, regardless of what treatment is used.


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