Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/44982
Title: Pharmaco-Invasive Strategy With Half-Dose Tenecteplase in Patients With STEMI: Prespecified Pooled Analysis of Patients Aged ≥75 Years in STREAM-1 and 2
Authors: Bainey, Kevin R.
Welsh, Robert C.
Zheng, Yinggan
Arias-Mendoza, Alexandra
Ristic, Arsen D.
Averkov, Oleg V.
Lambert, Yves
Kerr Saraiva, Jose F.
Sepulveda, Pablo
Rosell-Ortiz, Fernando
French, John K.
Music, Ljilja B.
Temple, Tracy
Ly, Eric
BOGAERTS, Kris 
Sinnaeve, Peter R.
Danays, Thierry
Westerhout, Cynthia M.
van de Werf, Frans
Armstrong, Paul W.
Issue Date: 2024
Publisher: LIPPINCOTT WILLIAMS & WILKINS
Source: Circulation-cardiovascular Interventions, 17 (12) (Art N° e014251)
Abstract: BACKGROUND: In STREAM-1 (Strategic Reperfusion Early After Myocardial Infarction), excess intracranial hemorrhage occurred in patients aged >= 75 years receiving full-dose tenecteplase as part of a pharmaco-invasive strategy, whereas no further intracranial hemorrhage occurred after halving the tenecteplase dose. In STREAM-2 (Second Strategic Reperfusion Early After Myocardial Infarction), half-dose tenecteplase was an effective and safe pharmaco-invasive strategy in older patients with ST-segment-elevation myocardial infarction presenting within <3 hours, compared with primary percutaneous coronary intervention (PCI). We prespecified evaluating the efficacy and safety of a half-dose versus full-dose pharmaco-invasive strategy and compared the half-dose pharmaco-invasive strategy to primary PCI in patients aged >= 75 years. METHODS: We pooled data sets in patients aged >= 75 years from STREAM-1 and STREAM-2 receiving a pharmaco-invasive strategy versus primary PCI. Resolution of ST-segment-elevation after fibrinolysis and angiography was assessed, as was the relative risk of the primary composite of 30-day all-cause death, myocardial infarction, heart failure, and shock, along with bleeding. RESULTS: A total of 390 patients were included: 42 patients were randomized to full-dose pharmaco-invasive treatment, 205 patients to half-dose pharmaco-invasive treatment, and 143 patients to primary PCI. Half-dose versus full-dose pharmaco-invasive treatment resulted in similar proportions of patients achieving >= 50% ST-segment resolution posttenecteplase (63.2% versus 62.6%), with reduced intracranial hemorrhage (7.1% versus 0%, respectively). Half-dose pharmaco-invasive treatment and primary PCI also had similar proportions of patients with >= 50% ST-segment resolution postangiography (77.9% versus 72.4%; P=0.277) and comparable composite end points (23.4% versus 28.0%; relative risk, 0.90 [95% CI, 0.62-1.30]; P=0.567) without occurrence of intracranial hemorrhage. CONCLUSIONS: Comparable efficacy exists between half- and full-dose tenecteplase pharmaco-invasive treatments with improved safety in patients with ST-segment-elevation myocardial infarction aged >= 75 years. Half-dose pharmaco-invasive therapy is a legitimate therapeutic option for elderly patients with ST-segment-elevation myocardial infarction unable to access timely primary PCI. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00623623. URL: https://www.clinicaltrials.gov; Unique identifier: NCT02777580.
Notes: Armstrong, PW (corresponding author), Univ Alberta, Katz Grp Ctr Pharm & Hlth Res, Edmonton, AB T6G 2E1, Canada.
Robert.Welsh@ahs.ca; yinggan@ualberta.ca; aariasm@yahoo.com;
arsen.ristic@med.bg.ac.rs; yl.samu78@wanadoo.fr; pablosep@gmail.com;
fernandorosell@gmail.com; j.french@unsw.edu.au; ttemple@ualberta.ca;
ely@ualberta.ca; kris.bogaerts@kuleuven.be;
thierry.danays.ext@boehringer-ingelheim.com; paul.armstrong@ualberta.ca
Keywords: fibrinolysis;intracranial hemorrhages;myocardial infarction;percutaneous coronary interventionre;perfusion
Document URI: http://hdl.handle.net/1942/44982
ISSN: 1941-7640
e-ISSN: 1941-7632
DOI: 10.1161/CIRCINTERVENTIONS.124.014251
ISI #: 001376094300009
Category: A1
Type: Journal Contribution
Appears in Collections:Research publications

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