STREAM-Strategic Reperfusion With Tenecteplase and Antithrombotic Treatment Early After Myocardial Infarction

This trial confirmed that fibrinolysis with tenecteplase and contemporary antithrombotic therapy given before transport to a PCI-capable hospital, coupled with timely coronary angiography, is as effective as primary PCI in STEMI patients presenting within 3 hours of symptom onset who cannot undergo primary PCI within 1 hour of first medical contact.
There was a significant increase in intracranial hemorrhage in the fibrinolysis group, which led to the dose of tenecteplase being halved in people aged 75 years or older fairly early on in the course of the trial, after which the intracranial hemorrhage rate in the fibrinolysis group was reduced to 0.5%,which was not significantly different from the PCI group.
“The results provide the opportunity for a measured approach to invasive coronary interventions, circumventing an urgent procedure in about two thirds of fibrinolytic-treated STEMI patients,” said Dr. Frans Van de Werf (University of Leuven, Belgium)
The trial may impact the management of STEMI, and probably improve outcomes of this severe heart attack

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