BENEFIT OF EARLY SUSTAINED REPERFUSION IN PATIENTS WITH PRIOR MYOCARDIAL-INFARCTION (THE GUSTO-I TRIAL)

The primary objective of this study was ta characterize a large cohort of patients receiving thrombolytic therapy for acute myocardial infar ction with respect to the group with a prior event. Patients were rand omly assigned to 1 of 4 thrombolytic strategies, Baseline characterist ics, 30-day outcomes, and 1-year mortality were compared between patie nts with (n = 6,704) and without (n = 34,143) prior myocardial infarct ion. Patients with prior myocardial infarction presented to the hospit al earlier than those having their first event, but institution of thr ombolytic 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 patie nts with prior infarction, and independent of other demographic variab les. Accelerated alteplase was more effective than streptokinase or co mbination 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 potency did not dif fer 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 hea led 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 reperfusi on therapy with accelerated alteplase. (C) 1998 by Excerpta Medica, In c.