For older patients with ST elevation MI where timely primary PCI is not possible, a pharmaco-invasive approach with half-dose tenecteplase is an effective alternative strategy, a new trial suggests. ACC23 WCCardio
Giving half-dose thrombolytic to ST-elevation myocardial infarction patients who are going to have a delay in receiving primary percutaneous coronary intervention , provided effective reperfusion based on ST-deviation resolution and angiographic results in the STREAM-2 trial.
Previous trials have shown increasing rates of intracranial hemorrhage and major non-intracranial bleeding in the older population with full-dose thrombolysis, with rates starting to increase from age 60, he noted. The efficacy endpoints of primary interest were the percentage of patients with more than 50% ST-segment resolution after tenecteplase and before and after PCI, the need for rescue PCI, and the combined clinical endpoint of death, cardiogenic shock, reinfarction, and heart failure at 30 days. Key safety outcomes were ICH and major non-ICH bleeding within 30 days.
Angiographic results before PCI showed TIMI-3 flow in 53.8% of the lytic groups vs 18.9% of the control group . In terms of safety, ICH occurred in six patients in the lytic group vs zero patients in the control group.
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