Abstract

To the Editor: Ross et al1 (April 28, 1998) report that in the GUSTO-1 angiographic substudy, successful reperfusion produced mortality benefits that were amplified beyond the first 30 days. This extended mortality benefit has been reported previously in the Grampian Region Early Anistreplase Trial (GREAT).2 In this randomized, double-blind, controlled clinical trial, 311 patients with suspected acute myocardial infarction either received anistreplase prehospital at 105 minutes (median) after symptom onset or in hospital at 240 minutes. At 30 days, there was a trend in favor of prehospital thrombolysis (≈6 lives saved per 100), but this did not reach statistical significance …

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