{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T10:08:07Z","timestamp":1791886087910,"version":"4.3.4"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Interventions"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>In STREAM-1 (Strategic Reperfusion Early After Myocardial Infarction), excess intracranial hemorrhage occurred in patients aged \u226575 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\u2013elevation myocardial infarction presenting within &lt;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 \u226575 years.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>We pooled data sets in patients aged \u226575 years from STREAM-1 and STREAM-2 receiving a pharmaco-invasive strategy versus primary PCI. Resolution of ST-segment\u2013elevation 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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>\n              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 \u226550% 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 \u226550% ST-segment resolution postangiography (77.9% versus 72.4%;\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.277) and comparable composite end points (23.4% versus 28.0%; relative risk, 0.90 [95% CI, 0.62\u20131.30];\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.567) without occurrence of intracranial hemorrhage.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>Comparable efficacy exists between half- and full-dose tenecteplase pharmaco-invasive treatments with improved safety in patients with ST-segment\u2013elevation myocardial infarction aged \u226575 years. Half-dose pharmaco-invasive therapy is a legitimate therapeutic option for elderly patients with ST-segment\u2013elevation myocardial infarction unable to access timely primary PCI.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>REGISTRATION:<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              ; Unique identifier: NCT00623623. URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              ; Unique identifier: NCT02777580.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circinterventions.124.014251","type":"journal-article","created":{"date-parts":[[2024,12,17]],"date-time":"2024-12-17T19:00:58Z","timestamp":1734462058000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Pharmaco-Invasive Strategy With Half-Dose Tenecteplase in Patients With STEMI: Prespecified Pooled Analysis of Patients Aged \u226575 Years in STREAM-1 and 2"],"prefix":"10.1161","volume":"17","clinical-trial-number":[{"clinical-trial-number":"nct00623623","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct02777580","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5458-4617","authenticated-orcid":true,"given":"Kevin R.","family":"Bainey","sequence":"first","affiliation":[{"name":"Canadian VIGOUR Centre (K.R.B., R.C.W., Y.Z., T.T., E.L., C.M.W., P.W.A.), University of Alberta, Edmonton, Canada."},{"name":"Mazankowski Alberta Heart Institute (K.R.B., R.C.W.), University of Alberta, Edmonton, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert C.","family":"Welsh","sequence":"additional","affiliation":[{"name":"Canadian VIGOUR Centre (K.R.B., R.C.W., Y.Z., T.T., E.L., C.M.W., P.W.A.), University of Alberta, Edmonton, Canada."},{"name":"Mazankowski Alberta Heart Institute (K.R.B., R.C.W.), University of Alberta, Edmonton, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2246-3683","authenticated-orcid":true,"given":"Yinggan","family":"Zheng","sequence":"additional","affiliation":[{"name":"Canadian VIGOUR Centre (K.R.B., R.C.W., Y.Z., T.T., E.L., C.M.W., P.W.A.), University of Alberta, Edmonton, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5942-4102","authenticated-orcid":true,"given":"Alexandra","family":"Arias-Mendoza","sequence":"additional","affiliation":[{"name":"Coronary Care Unit, National Institute of Cardiology, Mexico City, Mexico (A.A.-M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0713-1180","authenticated-orcid":true,"given":"Arsen D.","family":"Ristic","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Clinical Center of Serbia, University of Belgrade, Serbia (A.D.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3010-755X","authenticated-orcid":true,"given":"Oleg V.","family":"Averkov","sequence":"additional","affiliation":[{"name":"Pirogov Russian National Research Medical University and City Clinical Hospital, Moscow (O.V.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8108-9881","authenticated-orcid":true,"given":"Yves","family":"Lambert","sequence":"additional","affiliation":[{"name":"Centre Hospitalier de Versailles, Service d'aide M\u00e9dicale Urgente 78 and Mobile Intensive Care Unit, Le Chesnay, France (Y.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3345-8862","authenticated-orcid":true,"given":"Jos\u00e9 F.","family":"Kerr Saraiva","sequence":"additional","affiliation":[{"name":"Cardiology Discipline, Pontifical Catholic University of Campinas School of Medicine, Brazil (J.F.K.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7027-6473","authenticated-orcid":true,"given":"Pablo","family":"Sepulveda","sequence":"additional","affiliation":[{"name":"Pontifica Universidad Cat\u00f3lica de Chile, Santiago (P.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0260-9955","authenticated-orcid":true,"given":"Fernando","family":"Rosell-Ortiz","sequence":"additional","affiliation":[{"name":"Servicio de Urgencias y Emergencias 061 de La Rioja, Logro\u00f1o, Spain (F.R.-O.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9460-2621","authenticated-orcid":true,"given":"John K.","family":"French","sequence":"additional","affiliation":[{"name":"School of Medicine, University of New South Wales, Sydney, Australia (J.K.F.)."},{"name":"Department of Cardiology, Liverpool Hospital, Sydney, Australia (J.K.F.)."},{"name":"School of Medicine, Western Sydney University, Australia (J.K.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ljilja B.","family":"Musi\u0107","sequence":"additional","affiliation":[{"name":"Cardiology Clinic, Medical Faculty, University Clinical Center of Montenegro, University of Podgorica (L.B.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7616-9730","authenticated-orcid":true,"given":"Tracy","family":"Temple","sequence":"additional","affiliation":[{"name":"Canadian VIGOUR Centre (K.R.B., R.C.W., Y.Z., T.T., E.L., C.M.W., P.W.A.), University of Alberta, Edmonton, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4256-3338","authenticated-orcid":true,"given":"Eric","family":"Ly","sequence":"additional","affiliation":[{"name":"Canadian VIGOUR Centre (K.R.B., R.C.W., Y.Z., T.T., E.L., C.M.W., P.W.A.), University of Alberta, Edmonton, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0188-8665","authenticated-orcid":true,"given":"Kris","family":"Bogaerts","sequence":"additional","affiliation":[{"name":"Interuniversity Institute for Biostatistics and Statistical Bioinformatics, KU Leuven, Leuven and University Hasselt, Belgium (K.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4716-5892","authenticated-orcid":true,"given":"Peter R.","family":"Sinnaeve","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, KU Leuven, Belgium (P.R.S., F.V.d.W.)."},{"name":"Department of Cardiovascular Medicine, University Hospitals Leuven, Belgium (P.R.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0594-6490","authenticated-orcid":true,"given":"Thierry","family":"Danays","sequence":"additional","affiliation":[{"name":"TDC, Aix en Provence, France (T.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1082-5981","authenticated-orcid":true,"given":"Cynthia M.","family":"Westerhout","sequence":"additional","affiliation":[{"name":"Canadian VIGOUR Centre (K.R.B., R.C.W., Y.Z., T.T., E.L., C.M.W., P.W.A.), University of Alberta, Edmonton, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9479-7767","authenticated-orcid":true,"given":"Frans","family":"Van de Werf","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, KU Leuven, Belgium (P.R.S., F.V.d.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0460-3445","authenticated-orcid":true,"given":"Paul W.","family":"Armstrong","sequence":"additional","affiliation":[{"name":"Canadian VIGOUR Centre (K.R.B., R.C.W., Y.Z., T.T., E.L., C.M.W., P.W.A.), University of Alberta, Edmonton, 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SENIOR PAMI. A prospective randomized trial of primary angioplasty and thrombotic therapy in elderly patients with acute myocardial infarction. Presented at TCT; 2005."},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2010.06.050"}],"container-title":["Circulation: Cardiovascular Interventions"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCINTERVENTIONS.124.014251","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T21:09:30Z","timestamp":1748552970000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCINTERVENTIONS.124.014251"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12]]},"references-count":20,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2024,12]]}},"alternative-id":["10.1161\/CIRCINTERVENTIONS.124.014251"],"URL":"https:\/\/doi.org\/10.1161\/circinterventions.124.014251","relation":{},"ISSN":["1941-7640","1941-7632"],"issn-type":[{"value":"1941-7640","type":"print"},{"value":"1941-7632","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12]]},"assertion":[{"value":"2024-04-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-09-18","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-12-17","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}