The Strategic Reperfusion Early After Myocardial Infarction (STREAM) study
Section snippets
Trial methods
The trial was designed to enroll patients presenting within 3 hours of symptom onset who demonstrate acute STEMI and in whom primary PCI is not feasible within 60 minutes of a qualifying diagnostic electrocardiogram (ECG) (first medical contact).
The trial is an open-label, prospective, randomized, parallel, comparative, international multicenter trial. The inclusion and exclusion criteria are depicted in Table I. Patients are randomized to a strategy of fibrinolysis with tenecteplase coupled
Discussion
Since the Strategic Reperfusion Early After Myocardial Infarction (STREAM) protocol was designed in 2007 and commenced in 2008, the care of patients with STEMI has continued to evolve. Despite multiple attempts at facilitation with full-dose fibrinolysis or combination therapy, this approach to reperfusion has not proven to be successful.20, 21 What has proven to be useful however is strategic cointervention with timely rescue of patients receiving fibrinolysis and coronary revascularization in
Disclosures
Funding for this trial was provided by Boehringer Ingelheim. The sponsor and executive committee were responsible for the design and conduct of the trial. The academic authors vouch for the integrity and completeness of the data and analyses.
Acknowledgements
We would like to acknowledge the collaboration of Anne Regelin (Trial Clinical Monitor, Boehringer-Ingelheim), Katleen Vandenberghe (Leuven Coordinating Center), Tracy Temple (Canadian VIGOUR Center), and Yuling Fu and Hany Siha (ECG Core Laboratory, Canadian VIGOUR Center) as well as the editorial assistance of Jo-An Padberg.
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Cited by (73)
Barriers to the implementation of prehospital thrombolysis in the treatment of ST-segment elevation myocardial infarction in South Africa: An exploratory inquiry
2020, African Journal of Emergency MedicinePrimary PCI versus pharmacoinvasive strategy for ST elevation myocardial infarction
2018, IJC Heart and VasculatureCitation Excerpt :However, primary PCI is performed in <25% of acute care hospitals in the United States [1]. Many patients with STEMI present to hospitals that do not have on site PCI capabilities and therefore cannot undergo PCI within the timelines recommended in the guidelines; instead, they receive fibrinolytics as the initial reperfusion therapy [2]. Despite the effectiveness and worldwide availability of intravenous thrombolysis, the usefulness of this therapy is greatly threatened by a high proportion of failed reperfusion and a substantial rate of re-occlusion [3].
Implementation of a Nationwide Strategy for the Prevention, Treatment, and Rehabilitation of Cardiovascular Disease “A Todo Corazón”
2018, Archives of Medical ResearchCitation Excerpt :Although the global trend is to increase primary angioplasty and data has consistently shown greater benefits in multiple randomized clinical trials, there is point of equivalence between both treatments in the first 2 h of after clinical presentation, so that in places with limited access to a cath lab, fibrinolytic therapy provides benefits to patients without absolute contraindications that increase the risks of bleeding. To continue with a pharmacoinvasive strategy between the 2–24 h (26) (Figure 4). Adjunct therapy is essential to the success of the strategies of reperfusion, which includes the use of antiplatelet agents (aspirin, clopidogrel, heparin and some new antiplatelet) (27,28), associated with the suitable use of beta blockers (29), statins (30) and calcium antagonists (in the absence of contraindications).
Clinical Trial Identifier: NCT00623623 on clinicaltrials.gov.
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See online Appendix for a complete listing of STREAM Steering Committee.