• STEMI patients given tenecteplase- routine PCI within 6 hours (pharmacoinvasive approach) vs standard therapy (rescue PCI if chest pain, poor ST resolution or hemodynamic instability)
  • At 30 day follow-up, the primary endpoint of death, heart failure, myocardial infarction, recurrent ischemia or shock occurred in 11% of pharmacoinvasive group vs in 17% of standard therapy group.
  • Major bleeding was same in both groups.
  • Suggests that if patient presents to a hospital without facility for PCI, give thrombolytic therapy and shift to a hospital with PCI facility for immediate coronary angiography with intention to do PCI.
  • N Engl J Med 2009;360:2705-18