Search for: [Abstract = "Purpose\: Reperfusion strategy using full\-dose lytics followed by immediate PCI \(facilitated PCI\) in STEMI is harmful. However combination of prehospital lysis with delayed PCI \(pharmaco\-invasive treatment\) can be beneficial, especially in patients presenting early with long time delay to intervention. Methods\: We randomized 45 pts with STEMI < 3h from pain onset, with anticipated delay to PCI >90 minutes to receive prehospital tenecteplase \(TNK group, n=22\) or to be scheduled for PPCI \(PPCI group, n=23\). All patients underwent coronary angio\/PCI after cathlab admission. Primary endpoint was the infarct size \(%\) and end\-diastolic volume index \(LVEDVI, ml\/m2\) as a marker of LV remodeling assessed by delayed enhancement cardiac magnetic resonance \(CMR\) at 6\-months. Results\: Time from first medical contact to intervention was similar in both groups \(TNK vs PPCI\: 144±51 vs 129±24 minutes\; p=0.21\). Angiography revealed more frequent infarct\-related artery patency in TNK group \(TIMI 2\+3\: 81% vs 43%\; p=0.01\). Better ST\-segment resolution before PCI was found in TNK group \(resolution >70%\: 53% vs 6%\; p=0.003\). After PCI no difference in TIMI 3 flow and ST\-segment resolution >70% rate was found. The 6\-month CMR infarct size was significantly lower in TNK group \(7.4±6 vs 11.1±5.6, p=0.019\). The 6\-month CMR LVEDVI was also lower in TNK group \(69.3±21.5 vs 86.3±23.4, p=0.018\). Conclusions\: In patients with early presentation of STEMI transferred for mechanical reperfusion with time delay from first medical contact to intervention >90 minutes faster reperfusion with prehospital thrombolysis followed by PCI resulted in lower infarct size and LV remodeling at 6\-month follow up in comparison to primary PCI. Large scale clinical trials are needed to compare clinical outcomes of those two strategies."]

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