Feasibility and Safety of Low-Dose Intra-Coronary Tenecteplase During Primary Percutaneous Coronary Intervention for...

Area of Science:

• Cardiology
• Interventional Cardiology
• Biomedical Engineering

Background:

• Microvascular perfusion impairment after primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) is common.
• Thrombotic embolization contributes to this microvascular dysfunction.
• Intracoronary (IC) fibrinolytic therapy is a potential strategy to reduce thrombotic burden and distal embolization.

Purpose of the Study:

• To evaluate the feasibility and safety of low-dose IC tenecteplase (TNK) administration during PPCI.
• To assess the impact of IC TNK on thrombus burden and microvascular perfusion markers.

Main Methods:

• The ICE-T-TIMI-49 study randomized 40 PPCI patients to receive either IC TNK (4 mg) or IC saline placebo.
• IC TNK or placebo was administered as a volume-matched bolus before and after PPCI.
• Primary endpoint was percent diameter stenosis; secondary endpoints included thrombus reduction and corrected Thrombolysis In Myocardial Infarction (cTFC) frame count.

Main Results:

• The primary endpoint of percent diameter stenosis did not differ significantly between the IC TNK and placebo groups.
• A trend towards greater thrombus reduction was observed in the IC TNK group (40.0% vs 12.5% for placebo).
• Corrected TIMI frame count (cTFC) was lower (faster flow) in the placebo group, with a trend towards more hyperemia (a marker of distal embolization) in the TNK group (50.0% vs 8.3%). No significant difference in TIMI major bleeds or intracranial hemorrhage was noted.

Conclusions:

• Low-dose IC TNK is safe and well-tolerated during PPCI for STEMI.
• IC TNK did not improve percent stenosis but showed a trend towards reduced thrombus burden and distal embolization.
• Findings support further investigation in a large randomized trial to confirm efficacy.