GUSTO I trial

Last reviewed 07/2022

The GUSTO trial compared thrombolytic regimes and the effects of different means of heparin administration:

  • streptokinase versus tissue plasminogen activator
  • intravenous versus subcutaneous heparin

The GUSTO trial demonstrated that:

  • improved survival was associated with the administration of recombinant tissue plasminogen activator (t-PA) in an accelerated dosing schedule as compared with streptokinase

  • the optimum regime is accelerated t-PA with intravenous heparin

  • there is no significant difference in mortality between the use of intravenous and subcutaneous heparin when used in conjunction with normal dose streptokinase

The study supports the hypothesis that more rapid and complete restoration of coronary blood flow through the affected artery results in improved ventricular performance and lower mortality among patients with myocardial infarction.


  • The GUSTO investigators. (1993). An international randomised trial comparing four thrombolytic strategies for acute myocardial infarction. New Engl. J. Med. 329, 673-82.
  • The GUSTO investigators. (1993). The effects of tissue plasminogen activator, streptokinase, or both on coronary-artery patency, ventricular function, and survival after acute myocardial infarction. New Engl. J. Med. 329, 1615-22.