Tenecteplase: Innovative Fibrinolysis for ST-Segment Elevation Myocardial Infarction (STEMI)

Infarct Survival (the ISIS-2 trial), 8 mortality in patients who received streptokinase and aspirin was significantly lower than in patients who received no specific treatment (8.0% vs. 13.2%, P < .0001) and in patients who received streptokinase or aspirin alone. However, in the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries study (the GUSTO I trial), streptokinase did not produce as rapid or complete restoration of coronary flow as alteplase, a recombinant version of the naturally occurring tissue plasminogen activator (t-PA) molecule. 5,9 Mortality in the GUSTO I trial was lowest in patients with normal coronary flow (Thrombolysis in Myocardial Infarction [TIMI] grade 3) at 90 minutes (4.4%) and highest in patients with no flow (8.9%, P = .009). Overall, mortality in the patients receiving alteplase was an absolute 1% lower than in the patients receiving streptokinase. As a result of the GUSTO I findings, alteplase became the “gold standard” fibrinolytic agent for the treatment of STEMI.