Research from the STREAM-1 and STREAM-2 trials highlights the benefits of using half-dose tenecteplase, a clot-busting drug used to prevent death, for treating elderly patients (aged ≥75 years) with ST-segment elevation myocardial infarction (STEMI). STREAM-1 found that full-dose tenecteplase increased the risk of intracranial hemorrhage in this age group, while halving the dose eliminated this risk. STREAM-2 confirmed that half-dose tenecteplase was both effective and safe compared to primary percutaneous coronary intervention (PCI), a procedure used to open a blocked artery, for patients presenting within 3 hours of symptom onset. In a pre-specified pooled analysis of clinical and ECG data from these two trials, researchers evaluated the efficacy and safety of the pharmaco-invasive strategy of full- versus half-dose tenecteplase and compared the half-dose strategy to primary PCI.
The analysis included data from both trials for 390 patients who were aged ≥75 years and receiving a pharmaco-invasive strategy versus primary PCI. Of these patients, 42 were randomized to full-dose pharmaco-invasive treatment, 205 to half-dose pharmaco-invasive treatment, and 143 to primary PCI.
In this patient population, researchers found half- and full-dose tenecteplase pharmaco-invasive therapies had similar efficacy and enhanced safety. Their findings indicate that for older patients with STEMI who are unable to receive timely primary PCI, half-dose pharmaco-invasive therapy is a valid treatment option. This study offers a practical alternative to primary PCI for a global community grappling with an aging population and limited access to timely coronary angiography.
This research was conducted on behalf of the STREAM-2 investigators, and CVC co-authors include Kevin Bainey, MD, MSc; Robert Welsh, MD; Yinggan (Gray) Zheng, MA, MEd; Tracy Temple, BSc N, RN; Eric Ly, BHK; Cindy Westerhout, PhD; and Paul Armstrong, MD.