The STREAM-1 trial demonstrated that full-dose tenecteplase (TNK) increased the risk of intracranial hemorrhage in elderly patients (≥75 years) with ST-elevation myocardial infarction (STEMI), while a half-dose eliminated this risk. Subsequently, the STREAM-2 trial confirmed the efficacy and safety of half-dose TNK compared to primary percutaneous coronary intervention (PPCI) in STEMI patients ≥60 years presenting within 3 hours of symptom onset. Although no treatment variation was observed based on age (±75 years), the effectiveness of half-dose pharmaco-invasive therapy in patients under 75 remains unclear. To address this gap, a recent study analysed data on full-dose (STREAM-1) and half-dose TNK (STREAM-2) to evaluate the relative efficacy and safety of these pharmaco-invasive approaches in a younger STEMI population.
In a patient population aged 60 to <75 years from the STREAM-1 and STREAM-2 trials, the researchers compared the resolution of ST-elevation after fibrinolysis and angiography, the 30-day composite of all-cause death, myocardial infarction, heart failure, and shock, and safety events in those receiving pharmaco-invasive treatment versus PPCI. A total of 1103 patients were included, with 327 receiving full-dose pharmaco-invasive treatment (STREAM-1), 289 receiving half-dose pharmaco-invasive treatment (STREAM-2), and 487 receiving PPCI (338 in STREAM-1, 149 in STREAM-2).
The study demonstrated that half-dose pharmaco-invasive treatment offers comparable efficacy to full-dose treatment, with a reduced bleeding risk in this younger STEMI cohort. Based on these findings, lead author Dr. Kevin Bainey indicates, “we now have a good reason to use half-dose pharmaco-invasive treatment in younger patients aged 60 to <75 years old for STEMI.”
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.
