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In the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO I) trial, an accelerated infusion of alteplase resulted in complete patency of the infarcted vessel at 90 minutes in only 54% of the patients. Angiographic studies suggest that recombinant plasminogen activator (reteplase), a mutant of wild-type tissue plasminogen activator (alteplase) that has slower clearance, may achieve greater patency than alteplase. The GUSTO III study sought to determine whether a double-bolus administration of reteplase would reduce 30-day mortality by 20% compared with an accelerated infusion of alteplase.
Investigators randomized 15,059 patients from 807 hospitals in 20 countries who met standard criter…