BACKGROUND: Trials report a 2% to 6% incidence of reinfarction after fibrinolysis for acute @entity583 ( @entity583 ). We combined the Global Utilization of Streptokinase and @entity3479 for Occluded coronary arteries (GUSTO I) and Global Use of Strategies To Open occluded coronary arteries (GUSTO III) populations to better define frequency, timing, and clinical predictors of in-hospital reinfarction. METHODS AND RESULTS: In 55 911 @entity1 with ST-segment elevation @entity583 ( @entity583 ) who were receiving fibrinolysis, we compared baseline characteristics and mortality rate by reinfarction incidence and developed multivariable logistic regression models to @entity204 . Reinfarction occurred in 2258 @entity1 (4.3%) a median of 3.8 days after fibrinolysis; rates did not differ between GUSTO I (4.0%) and GUSTO III (4.2%) or by fibrinolytic assignment (streptokinase, 4.1%; @entity3479 , 4.3%; reteplase, 4.5%; combined streptokinase and @entity3479 , 4.4%; P=0.55). Advanced age, shorter time to fibrinolysis, non-US enrollment, nonsmoking status, prior @entity583 or @entity951 , female sex, anterior @entity583 , and lower systolic blood pressure were associated significantly with reinfarction. @entity1 with reinfarction had higher mortality at 30 days (11.3% versus 3.5% without reinfarction; odds ratio, 3.5; P<0.001) and from 30 days to 1 year (4.7% versus 3.2%; hazard ratio, 1.5; P<0.001). Significant multivariate predictors of in-hospital @entity204 or reinfarction included age, Killip class, systolic and diastolic blood pressures, heart rate, anterior @entity583 , smoking status, prior @entity583 , sex, and country of enrollment (all P<0.001). CONCLUSIONS: Reinfarction occurs infrequently after fibrinolysis but confers increased risk of 30-day and 1-year mortality. Some predictors of reinfarction differ from known predictors of @entity204 after @entity583 . Improved treatment and prevention strategies for reinfarction deserve study.

Early reinfarction after fibrinolysis: experience from the global utilization of streptokinase and XXXX for occluded coronary arteries (GUSTO I) and global use of strategies to open occluded coronary arteries (GUSTO III) trials.

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients'] @entity951 :: ('MESH:D000787', 'Disease') :: ['angina'] @entity583 :: ('MESH:D009203', 'Disease') :: ['myocardial infarction', 'MI'] @entity3479 :: ('5327', 'Gene') :: ['Tissue plasminogen activator (alteplase)', 'alteplase'] @entity204 :: ('MESH:D003643', 'Disease') :: ['predict in-hospital reinfarction and composite of death or reinfarction', 'death']
@entity3479 :: (5327,Gene) :: ['tissue plasminogen activator (alteplase)']
