Benefit of early sustained reperfusion in patients with prior myocardial infarction (The GUSTO-I Trial) Academic Article Article uri icon


MeSH Major

  • Angioplasty, Balloon, Coronary
  • Coronary Artery Disease
  • Drug-Eluting Stents
  • Heart Transplantation


  • The primary objective of this study was to characterize a large cohort of patients receiving thrombolytic therapy for acute myocardial infarction with respect to the group with a prior event. Patients were randomly assigned to 1 of 4 thrombolytic strategies. Baseline characteristics, 30-day outcomes, and 1-year mortality were compared between patients with (n = 6,704) and without (n = 34,143) prior myocardial infarction. Patients with prior myocardial infarction presented to the hospital earlier than those having their first event, but institution of thrombolytic therapy was delayed. Mortality at 30 days (11.7% vs 5.9%, p = 0.001) and 1 year (17.3% vs 8.2%, p < 0.001) was greater among patients with prior infarction, and independent of other demographic variables. Accelerated alteplase was more effective than streptokinase or combination therapy (30-day mortality 10.4% vs 12.2%, p = 0.012; 1-year mortality 15.9% vs 17.8%, p = 0.041). Infarct vessel patency did not differ between those with and without prior myocardial infarction (67.3% vs 67% at 90 minutes, p = 0.92); however, recurrent ischemia was more common in patients with prior myocardial infarction. Patients with healed myocardial infarction should be educated to ensure early hospital admission if they develop symptoms suggestive of acute infarction, and upon hospital arrival should be promptly triaged to receive reperfusion therapy with accelerated alteplase.

publication date

  • February 1998



  • Academic Article


Digital Object Identifier (DOI)

  • 10.1016/S0002-9149(97)00909-0

PubMed ID

  • 9468068

Additional Document Info

start page

  • 282

end page

  • 7


  • 81


  • 3