Selection of thrombolytic therapy for individual patients: development of a clinical model. GUSTO-I Investigators.
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.
Califf
R M
RM
Department of Medicine (Cardiology), Duke University Medical Center, Durham, N.C. 27710, USA. calif001@mc.duke.edu
Woodlief
L H
LH
Harrell
F E
FE
Lee
K L
KL
White
H D
HD
Guerci
A
A
Barbash
G I
GI
Simes
R J
RJ
Weaver
W D
WD
Simoons
M L
ML
Topol
E J
EJ
D000367:Age Factors; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use; D001794:Blood Pressure; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D005544:Forecasting; D006339:Heart Rate; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007275:Injections, Intravenous; D007279:Injections, Subcutaneous; D016015:Logistic Models; D008875:Middle Aged; D015233:Models, Statistical; D009203:Myocardial Infarction / Q000188:drug therapy*; D010960:Plasminogen Activators / Q000008:administration & dosage / Q000627:therapeutic use; D011379:Prognosis; D012307:Risk Factors; D013300:Streptokinase / Q000008:administration & dosage / Q000627:therapeutic use; D015996:Survival Rate; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006493:Heparin; D013300:Streptokinase; D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator