ABSTRACT
GUSTO IIb The Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) IIb compared a recombinant hirudin (desirudin) with UFH for 72 hours, in 12142 patients with acute coronary syndromes.27 Patients were stratified according to the presence or absence of ST-segment elevation on the baseline ECG. There were 8011 unstable angina/NQWMI patients. At 24 hours the risk of death or MI was significantly lower in the group assigned to hirudin therapy compared to UFH (1.3% vs 2.1%; p = 0.001). The primary endpoint of death or non-fatal MI or reinfarction at 30 days was reached in 9.8% of the UFH group compared to 8.9% of the hirudin group (p = 0.06). The predominant effect of hirudin was MI or reinfarction and this was not influenced by ST-segment status. This effect was more pronounced early (at 24 hours) but dissipated over time. Hirudin treatment was associated with a higher incidence of moderate bleeding (8.8% vs 7.7%; p = 0.03).
