1. Home>
2. Specialties>
3. Cardiology>
4. Summary and Comment

Reteplase plus Abciximab vs. Reteplase Alone in STEMI: 1-Year Data from GUSTO-V

Standard and combination therapy yielded identical 1-year mortality rates.

GUSTO-V was the first large-scale mortality trial to compare standard fibrinolytic therapy with glycoprotein IIb/IIIa inhibition plus reduced-dose fibrinolysis in patients with ST-segment-elevation MI (STEMI; Journal Watch Cardiology Aug 3 2001). In GUSTO-V, 16,588 STEMI patients were randomized to half-dose reteplase plus full-dose abciximab or to standard-dose reteplase.

Thirty-day mortality rates in GUSTO-V did not differ for the 2 approaches. However, the combination approach did yield lower 30-day rates of reinfarction, recurrent ischemia, and need for urgent revascularization, although it also had some early-bleeding disadvantages.

The GUSTO-V researchers now report 1-year mortality rates, which were identical for the 2 treatment groups (both 8.38%).

Comment: GUSTO-V showed no mortality benefit for half-dose reteplase plus full-dose abciximab over reteplase alone in STEMI patients. In addition, this combination approach was associated with more early bleeding. Combination therapy may have a potential role in facilitated percutaneous coronary intervention, but data from a large trial (e.g., FINESSE) are needed before such an approach can be advocated for treating STEMI patients undergoing primary PCI. Whether, in general, combination therapy should be an alternative to fibrinolysis for STEMI also requires further study.

— JoAnne M. Foody, MD

Published in Journal Watch Cardiology December 27, 2002

Citation(s):

Lincoff AM et al. Mortality at 1 year with combination platelet glycoprotein IIb/IIIa inhibition and reduced-dose fibrinolytic therapy vs conventional fibrinolytic therapy for acute myocardial infarction: GUSTO V randomized trial. JAMA 2002 Nov 6; 288:2130-5.

• Original article (Subscription may be required)
• Medline abstract (Free)