Pharmaco-Invasive Strategy With Half-Dose Tenecteplase in Patients With STEMI: Prespecified Pooled Analysis of Patients Aged ≥75 Years in STREAM-1 and 2

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dc.article.numbere014251
dc.catalogadorpva
dc.contributor.authorBainey, Kevin R.
dc.contributor.authorWelsh, Robert C.
dc.contributor.authorZheng, Yinggan
dc.contributor.authorArias-Mendoza, Alexandra
dc.contributor.authorRistic, Arsen D.
dc.contributor.authorAverkov, Oleg V.
dc.contributor.authorLambert, Yves
dc.contributor.authorKerr Saraiva, Jose F.
dc.contributor.authorSepúlveda Varela, Pablo Andrés
dc.contributor.authorRosell-Ortiz, Fernando
dc.contributor.authorFrench, John K.
dc.contributor.authorMusic, Ljilja B.
dc.contributor.authorTemple, Tracy
dc.contributor.authorLy, Eric
dc.contributor.authorBogaerts, Kris
dc.contributor.authorSinnaeve, Peter R.
dc.contributor.authorDanays, Thierry
dc.contributor.authorWesterhout, Cynthia M.
dc.contributor.authorvan de Werf, Frans
dc.contributor.authorArmstrong, Paul W.
dc.date.accessioned2025-03-05T20:52:25Z
dc.date.available2025-03-05T20:52:25Z
dc.date.issued2024
dc.description.abstractBACKGROUND: 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.
dc.description.funderDepartment of Research and Development of KU Leuven, Life Science Research Partners, and Boehringer Ingelheim
dc.fuente.origenWOS
dc.identifier.doi10.1161/CIRCINTERVENTIONS.124.014251
dc.identifier.eissn1941-7632
dc.identifier.issn1941-7640
dc.identifier.urihttps://doi.org/10.1161/CIRCINTERVENTIONS.124.014251
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/102384
dc.identifier.wosidWOS:001376094300009
dc.information.autorucEscuela de Medicina; Sepúlveda Varela, Pablo Andrés; 0000-0001-7027-6473; 1095919
dc.issue.numero12
dc.issue.numero12
dc.language.isoen
dc.nota.accesocontenido parcial
dc.publisherAmerican Heart Association
dc.revistaCirculation: Cardiovascular Interventions
dc.rightsacceso parcial
dc.subjectFibrinolysis
dc.subjectIntracranial hemorrhages
dc.subjectMyocardial infarction
dc.subjectPercutaneous coronary intervention
dc.subjectReperfusion
dc.subject.ddc610
dc.subject.deweyMedicina y saludes_ES
dc.subject.ods03 Good health and well-being
dc.subject.odspa03 Salud y bienestar
dc.titlePharmaco-Invasive Strategy With Half-Dose Tenecteplase in Patients With STEMI: Prespecified Pooled Analysis of Patients Aged ≥75 Years in STREAM-1 and 2
dc.typeartículo
dc.volumen17
sipa.codpersvinculados1095919
sipa.trazabilidadWOS;2024-12-28
sipa.trazabilidadORCID;2025-03-03
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