Validation of the early open infarct vessel hypothesis

The insights from the Global Utilization of Streptokinase and t-PA for Occluded Arteries (GUSTO) trial have paved the way for further refinement in myocardial reperfusion strategies. For the moment, there is a better pharmacologic approach for achieving rapid and complete coronary thrombolysis. However, for the future, the legacy from this project is much more meaningful, providing clear-cut validation of the "early open vessel hypothesis" while at the same time exemplifying how deficient our strategies for reperfusion are today. There are explicit signals for persistent, meaningful improvement in the years ahead.