Document Detail

The Strategic Reperfusion Early After Myocardial Infarction (STREAM) study.
MedLine Citation:
PMID:  20598969     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Primary percutaneous coronary intervention (PCI) has emerged as the preferred therapy for acute ST-elevation myocardial infarction (STEMI) provided it is performed in a timely fashion at an expert 24/7 facility. Fibrinolysis is a well-accepted alternative, especially in patients presenting early after symptom onset. The STREAM study will provide novel information on whether prompt fibrinolysis at first medical contact, followed by timely catheterization or rescue coronary intervention in STEMI patients presenting within 3 hours of symptom onset, represents an appropriate alternative strategy to primary PCI. METHODS: Acute STEMI patients presenting early after symptom onset are eligible if PCI is not feasible within 60 minutes of first medical contact. This is an open-label, prospective, randomized, parallel, comparative, international multicenter trial. Patients are randomized to fibrinolysis combined with enoxaparin, clopidogrel, and aspirin, and cardiac catheterization within 6 to 24 hours or rescue coronary intervention if reperfusion fails within 90 minutes of fibrinolysis versus PCI performed according to local guidelines. Composite efficacy end points at 30 days include death, shock, heart failure, and reinfarction. Safety end points include ischemic stroke, intracranial hemorrhage, and major nonintracranial bleeding. Follow-up is extended to 1 year and includes all-cause mortality. DISCUSSION: Continuing delays in achieving timely PCI remain a difficult issue. Many patients fail to achieve the desired reperfusion times of 90 to 120 minutes after first medical contact. The STREAM results will provide useful additional data on which to base informed therapeutic decisions.
Paul W Armstrong; Anthony Gershlick; Patrick Goldstein; Robert Wilcox; Thierry Danays; Erich Bluhmki; Frans Van de Werf;
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American heart journal     Volume:  160     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-05     Completed Date:  2010-08-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  30-35.e1     Citation Subset:  AIM; IM    
Copyright Information:
Copyright (c) 2010 Mosby, Inc. All rights reserved.
University of Alberta, Edmonton, Alberta, Canada.
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MeSH Terms
Aspirin / therapeutic use
Cause of Death
Drug Therapy, Combination
Enoxaparin / therapeutic use
Fibrinolytic Agents / therapeutic use*
Follow-Up Studies
Heart Catheterization
Myocardial Infarction / drug therapy*,  mortality,  physiopathology
Myocardial Reperfusion / methods*
Platelet Aggregation Inhibitors / therapeutic use*
Prospective Studies
Survival Rate / trends
Thrombolytic Therapy / methods*
Ticlopidine / analogs & derivatives,  therapeutic use
Time Factors
Treatment Outcome
Reg. No./Substance:
0/Enoxaparin; 0/Fibrinolytic Agents; 0/Platelet Aggregation Inhibitors; 50-78-2/Aspirin; 55142-85-3/Ticlopidine; 90055-48-4/clopidogrel
Frans Van de Van de Werf / ; Paul Armstrong / ; Anthony Gershlick / ; Robert Wilcox / ; Patrick Goldstein / ; Lars Aaberge / ; Jennifer Adgey / ; Hans-Richard Arntz / ; Fransisco Aviles / ; Claudio Fresco / ; Stefan Grajek / ; Sigrun Halvorsen / ; Kurt Huber / ; Jason Kendall / ; Yves Lambert / ; Philippe Meert / ; John Nanas / ; Miodrag Ostojic / ; Antonio Pesenti / ; Leopoldo Piegas / ; Tom J Quinn / ; Fernando Rosell / ; Wolfgang Schreiber / ; Peter Sinnaeve / ; Jon-Erik Steen-Hansen / ; P Gabriel Steg / ; Victor Sulimov / ; Sergio Timerman / ; Andrew Travers / ; Robert Welsh / ; Uwe Zeymer / ; Keith A A Fox / ; Gilles Montalescot / ; Charles Pollack / ; Jan Tijssen / ; Doug Weaver / ; Ron Brower /

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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