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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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