Results from the STREAM trial of 1,915 patients with ST-elevation myocardial infarction (STEMI), given Metalyse/TNKase (tenecteplase), from Boehringer, indicates that the drug offers some benefits compared to alternative PCI treatment. Patients were seen in community hospitals or by emergency medical personnel where angioplasty was not possible. Before transfer, subjects were randomized to either percutaneous coronary intervention immediately after arrival or to drug therapy with tenecteplase plus enoxaparine, clopidogrel and aspirin before arrival.
When patients on tenecteplase reached a medical center, about one-third needed urgent angioplasty. The other two-thirds did not. They received an angiogram an average of 17 hours after arrival. Based on the results of the angiogram, patients received either PCI or coronary artery bypass graft surgery under non-urgent circumstances. STREAM shows that patients receiving tenecteplase were more likely to have normal blood flow on an angiogram, compared with the PCI-only group (58 vs. 21 percent). They were less likely than the PCI-only group to have an angiogram show complete blockage of an artery (16 vs. 59 percent). More tenecteplase patients than PCI-only patients eventually underwent coronary artery bypass graft surgery. Results were presented at the American College of Cardiology's 62nd Annual Scientific Session.