Efficacy and safety of single-bolus tenecteplase compared with front-loaded alteplase in Chinese patients with acute myocardial infarction

Following ST-segment elevation myocardial infarction (STEMI), early and complete epicardial reperfusion is associated with improved survival.1 For decades, the only available pharmacologic intervention aimed at reperfusion was intravenous streptokinase (SK). The efficacy of (SK) was firmly established in the Italian Group for the Study of Streptokinase in Myocardial Infarction (GISSI-1) trial, which reported an 18% relative reduction in mortality among patients presenting with STEMI within 12 hours after the onset of symptoms.2 Despite the fact that tissue-plasminogen activator (t-PA) is associated more rapid dissolution of thrombus,3 three large-scale clinical trials did not report a difference in mortality between SK and alteplase t-PA.4-6 It took altering the method of administration of alteplase t-PA, so-called front-loading (i.e. two-thirds of the dose over the first 30 minutes and the remaining dose over 60 minutes) rather than a 3-hour infusion, to lower mortality by about 1% with alteplase t-PA over SK.7 The drawback of alteplase t-PA was a small but significant increase in the risk of hemorrhagic stroke.