Pharmaco-invasive strategy and dosing of tenecteplase in ST-elevation myocardial infarction (STEMI) patients 60 to <75 years: An inter-trial comparison of the STREAM-1 and STREAM-2 trials
Authors' conclusion
In STEMI patients 60 to <75 years presenting within 3 hours of symptoms, half-dose PI treatment appears as efficacious as a full-dose PI strategy with a low systemic bleeding risk. Half-dose PI treatment deserves consideration when timely PPCI is not attainable in this important STEMI sub-group.
Study context
- Population
- STEMI patients 60 to <75 years from STREAM-1 and STREAM-2 presenting within 3 hours of symptomsfull-dose pharmaco-invasive (PI) strategy (STREAM-1) 327 · half-dose PI strategy (STREAM-2) 289 · primary percutaneous coronary intervention (PPCI) 487 · PPCI in STREAM-1 338 · PPCI in STREAM-2 149
- Participants
- 1,103 patients
- Comparison
- PI strategies with full-dose (STREAM-1) versus half-dose TNK (STREAM-2); PI treatment versus PPCI
- Full-dose PI strategy (STREAM-1)n = 327
- Half-dose PI strategy (STREAM-2)n = 289
- PPCIn = 487
- Outcome
- Primary efficacy composite of:
- All-cause death
- Myocardial infarction
- Heart failure
- Shock
- Follow-up
- 30 days
Main finding
As reported in the abstract
PI (STREAM-1) vs PPCI (STREAM-1) · STREAM-1: 14.4% vs. 16.3%
0.90
CI 0.62–1.31
PI (STREAM-2) vs PPCI (STREAM-2) · STREAM-2: 9.0% vs 8.1%
1.29
CI 0.64–2.61
Further findings
| Outcome | Full-dose PI strategy (STREAM-1) | Half-dose PI strategy (STREAM-2) | P value |
|---|---|---|---|
| ST resolution ≥50% after fibrinolysisHalf-dose PI strategy (STREAM-2) vs full-dose PI strategy (STREAM-1) | 68.7% | 71.2% | P = 0.519 |
- ST resolution ≥50% following angiography · PI (STREAM-1) vs PPCI (STREAM-1) · 87.7% vs. 83.2% · PI patients had nominally better ST resolution
- P = 0.120
- ST resolution ≥50% following angiography · PI (STREAM-2) vs PPCI (STREAM-2) · 88.2% vs. 81.0% · PI patients had nominally better ST resolution
- P = 0.048
Safety
| Outcome | Full-dose PI strategy (STREAM-1) | Half-dose PI strategy (STREAM-2) | P value |
|---|---|---|---|
| ICHHalf-dose PI strategy (STREAM-2) vs full-dose PI strategy (STREAM-1) | 1.5% | 2.1% | P = 0.605 |
Major (non-ICH) bleeding
- STREAM-1 (PI vs PPCI)
- 7.1% vs. 6.0%
- STREAM-2 (PI vs PPCI)
- 0.3% vs. 0.7%
- Markedly declined in STREAM-2 compared to STREAM-1 in both treatment groups
Original publication
Pharmaco-invasive strategy and dosing of tenecteplase in STEMI patients 60 to <75 years: An inter-trial comparison of the STREAM-1 and STREAM-2 trials. Am Heart J. Published 12 February 2025. doi:10.
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