STrategic Reperfusion in Elderly Patients Early After Myocardial Infarction

Inclusion criteria

• Age equal or greater than 60 years
• Onset of symptoms < 3 hours prior to randomisation
• 12-lead ECG indicative of an acute STEMI (ST-elevation will be measured from the J point; scale: 1 mm per 0.1 mV):

• ≥ 2 mm ST-elevation across 2 contiguous precordial leads (V1-V6) or leads I and aVL for a minimum combined total of ≥ 4 mm ST-elevation or
• ≥ 2 mm ST-elevation in 2 contiguous inferior leads (II, III, aVF) for a minimum combined total of ≥ 4 mm ST-elevation
• Informed consent received

Exclusion criteria

• 1. Expected performance of PCI < 60 minutes from diagnosis (qualifying ECG) or inability to arrive at the catheterisation laboratory within 3 hours
• Previous CABG
• Left bundle branch block or ventricular pacing
• Patients with cardiogenic shock - Killip Class 4
• Patients with a body weight < 55 kg (known or estimated)
• Uncontrolled hypertension, defined as sustained blood pressure ≥ 180/110 mm Hg (systolic BP ≥ 180 mm Hg and/or diastolic BP ≥ 110 mm Hg) prior to randomisation
• Known prior stroke or TIA
• Recent administration of any i.v. or s.c. anticoagulation within 12 hours, including unfractionated heparin, enoxaparin, and/or bivalirudin or current use of oral anticoagulation (i.e. warfarin or a NOACs)
• Active bleeding or known bleeding disorder/diathesis
• Known history of central nervous system damage (i.e. neoplasm, aneurysm, intracranial or spinal surgery) or recent trauma to the head or cranium (i.e. < 3 months)
• Major surgery, biopsy of a parenchymal organ, or significant trauma within the past 2 months (this includes any trauma associated with the current myocardial infarction)
• Clinical diagnosis associated with increased risk of bleeding including known active peptic ulceration and/or neoplasm with increased bleeding risk
• Prolonged cardiopulmonary resuscitation (> 2 minutes) within the past 2 weeks
• Known acute pericarditis and/or subacute bacterial endocarditis
• Known acute pancreatitis or known severe hepatic dysfunction, including hepatic failure, cirrhosis, portal hypertension (oesophageal varices) and active hepatitis
• Dementia
• Known severe renal insufficiency
• Previous enrolment in this study or treatment with an investigational drug or device under another study protocol in the past 7 days
• Known allergic reactions to tenecteplase, clopidogrel, enoxaparin and aspirin
• Inability to follow the protocol and comply with follow-up requirements or any other reason that the investigator feels would place the patient at increased risk if the investigational therapy is initiated.