Related trials
		 
			
				 
				
					TRIANA, 2009 - primary ballon angioplasty  vs tenecteplase
				
			 
			
				 
				
					DEBATER (SES vs BMS), 2009 - sirolimus eluting stent  vs bare-metal stent
				
			 
			
				 
				
					NORDISTEMI, 2009 - thrombolysis + angioplasty  vs immediate thrombolysis
				
			 
			
				 
				
					Juwana, 2009 - sirolimus eluting stent  vs paclitaxel eluting stent
				
			 
			
				 
				
					ZEST AMI (vs PES), 2009 - zotarolimus eluting stent  vs paclitaxel eluting stent
				
			 
			
				 
				
					PASEO, 2009 - drug-eluting stents  vs bare-metal stent
				
			 
			
				 
				
					ZEST AMI (vs SES), 2009 - zotarolimus eluting stent  vs sirolimus eluting stent
				
			 
			
				 
				
					CARESS, 2008 - thrombolysis + angioplasty  vs immediate thrombolysis
				
			 
			
				 
				
					HORIZONS-AMI Stent, 2008 - paclitaxel eluting stent  vs bare-metal stent
				
			 
			
				 
				
					MISSION, 2008 - sirolimus eluting stent  vs bare-metal stent
				
			 
			
				 
				
					DEDICATION, 2008 - drug-eluting stents  vs bare-metal stent
				
			 
			
				 
				
					Díaz de la Llera, 2007 - sirolimus eluting stent  vs bare-metal stent
				
			 
			
				 
				
					SESAMI, 2007 - sirolimus eluting stent  vs bare-metal stent
				
			 
			
				 
				
					PROSIT, 2006 - sirolimus eluting stent  vs paclitaxel eluting stent
				
			 
			
				 
				
					HAAMU-STENT, 2006 - paclitaxel eluting stent  vs bare-metal stent
				
			 
			
				 
				
					PASSION, 2006 - paclitaxel eluting stent  vs bare-metal stent
				
			 
			
				 
				
					WEST, 2006 - systematic PCI (+stent)  vs no systematic PCI
				
			 
			
				 
				
					TYPHOON, 2006 - sirolimus eluting stent  vs bare-metal stent
				
			 
			
				 
				
					ZWOLLE 6, 2005 - primary stenting  vs balloon angioplasty
				
			 
			
				 
				
					CAPITAL AMI, 2005 - systematic PCI (+stent)  vs no systematic PCI
				
			 
			
				 
				
					senior PAMI, 2005 - primary PCI  vs Thrombolysis 
				
			 
			
				 
				
					CAPITAL AMI, 2005 - thrombolysis + angioplasty  vs immediate thrombolysis
				
			 
			
				 
				
					Di Lorenzo et al., 2005 - sirolimus eluting stent  vs paclitaxel eluting stent
				
			 
			
				 
				
					GRACIA-1, 2004 - systematic PCI (+stent)  vs no systematic PCI
				
			 
			
				 
				
					MERLIN (Sutton), 2004 - immediate systematic ballon angioplastyte  vs no immediate angioplasty
				
			 
		 
		 
		 
		
		See also:
		 
			
				
					All acute myocardial infarction clinical trials
				
			
		
			
			All clinical trials of PCI
			
		
		
			
			All clinical trials of primary ballon angioplasty
			
		
	 | 
	
		 
	 | 
	
	Treatments
	
	
		| Studied treatment | 
		
		Tenecteplase + UFH (+/- clopidogrel)
		 
		
		
		 | 
	 
	
		| Control treatment | 
		
		Primary angioplasty
		 
		
		single weight-adjusted dose of TNK along with UFH (60 U/kg bolus plus infusion with an aPTT 1.5-2)
		
		 | 
	 
			| Treatments description  | 
				
					
				 | 
			 
	 
	
	
	
	Patients
	
		
			| Patients | 
			>=75 years old with ST-segment elevation or LBBB AMI 
		 |  
		
			| Inclusion criteria | 
			age >=75 years; chest pain or any symptom of myocardial ischemia >=20 minutes of duration, not responding to nitrate therapy within first 6 hours and at least one of the following: ST-elevation >=2 mm in >=2 precordial leads, ST-elevation >=1 mm in >=2 anterior leads, or de novo (or probably de novo) LBBB
 | 
		 
		
			| Exclusion criteria | 
			Cardiogenic shock, estimated door-to-balloon time >120 minutes, administration of thrombolysis within 14 days prior to randomization, GP IIa/IIIb inhibitor within 24 hours prior to randomization, or LMWH within 8 hours prior to randomization, current oral anticoagulant treatment, suspected AMI secondary to occlusion of a coronary lesion treated previously with PCI, known renal failure, reduced expected life expectancy (180 mmHg or diastolic BP >110 mmHg; known thrombocytopenia 20 minutes) or traumatic cardiopulmonary resuscitation in the 2 weeks prior to randomization; symptoms or signs suggesting aortic dissection
 | 
		 
				| Baseline characteristics | 
					
					
						
							| Delay to treatment (PTCA vs thr) | 
							195min (Thr) / 245min (PCI)  | 
						 
						
							| % female | 
							44%  | 
						 
						
							| mean age | 
							81y  | 
						 
					 						
					 | 
				 
	 
	
	
	
	
	
	
	Method and design
	
	
		| Randomized effectives | 
		132 / 134 (studied vs. control) | 
	 
		
			| Design | 
			Parallel groups | 
		 
		
			| Blinding | 
			open | 
		 
		
			| Follow-up duration | 
			30 days (12 months) | 
		 
		
			| Primary endpoint | 
			Death or Reinfarction or Disabling stroke  | 
		 
	
	 
	
	
	
	
	
	
	
  
	Results	
	
	
	
		
	
	
		
			Endpoint
		
	
	
		
		Studied treat. n/N
			
	
	
		
		Control treat. n/N
		
	
	
		
			Graph
		
	
	
		
			RR [95% CI]
		
	
	
		
			
				
				MACE
				 
			
		
			
				
				NA / 132 
				
			
			
				
				NA / 134 
				
			
		
			
				
					
						classic
					
					
					
				
			
				
				
			
			
		
			
				
					1,46 [0,81;2,63]
				
			
	
	
		
			
				
				reinfarction
				 
			
		
			
				
				NA / 132 
				
			
			
				
				NA / 134 
				
			
		
			
				
					
						classic
					
					
					
				
			
				
				
			
			
		
			
				
					1,60 [0,60;4,26]
				
			
	
	
		
			
				
				In-hospital death 
				 
			
		
			
				
				NA / 132 
				
			
			
				
				NA / 134 
				
			
		
			
				
					
						classic
					
					
					
				
			
				
				
			
			
		
			
				
					1,31 [0,67;2,56]
				
			
	
	
		
			
				
				stroke (fatal and non fatal) 
				 
			
		
			
				
				NA / 132 
				
			
			
				
				NA / 134 
				
			
		
			
				
					
						classic
					
					
					
				
			
			
			
		
			
				
					4,03 [0,44;36,86]
				
			
	
	
		
		
		
		
		
			
				0
			
		
		
		
		
		
				2
		
		
		
		
		
			1.0
		
	
  
 
	 
		
	
		
		
				
					| 
						Relative risks
					 | 
				 
			
			| Endpoint | 
			Events (%) | 
			Relative Risk | 
			95% CI | 
			Endpoint definition in the trial | 
			Ref | 
			 
			
			| Studied treat. | 
			Control treat. | 
			 
					
					
					
					
					
					
		
			| 
			The primary endpoint (if exists) appears in blod characters
			 | 
		 
		
			| 
			Reference(s) used for data extraction: 
			 | 
		 
		 
		
		
			
			| Endpoint | 
			studied treat. | 
			control treat. | 
			mean diff | 
			 
		 
	 
	
	
	
				
					| 
						Absolute risk reduction 
					 | 
				 
	
		| Endpoint | 
		Events rate | 
		Absolute risk reduction (ARR) | 
	 
	
		| Studied treat. | 
		Control treat. | 
	 
	 	
	 
Meta-analysis of all similar trials: 
			
				
					myocardial revascularization in acute myocardial infarction for Elderly patients
				
			 
			
				
					myocardial revascularization in acute myocardial infarction for all type of patients
				
			 
			
				
					PCI in acute myocardial infarction for all type of patients
				
			 
			
				
					PCI in acute myocardial infarction for Elderly patients
				
			 
	
  
	
	
	
	
	
	
	
	
	
	
	
		 
		Reference(s)
	
	
	
			- 
				
			    Clauw et al. 
			    The efficacy and safety of milnacpran in the treatment of fibromyalgia.
			    2007, poster 716
			    
 
				
					 
					Pubmed
				 	
				|
				
					Hubmed
				
				| Fulltext
		 
		
			- 
				
			    Bueno H, Betriu A, Heras M, Alonso JJ, Cequier A, García EJ, López-Sendón JL, Macaya C, Hernández-Antolín R. 
			    Primary angioplasty vs. fibrinolysis in very old patients with acute myocardial infarction: TRIANA (TRatamiento del Infarto Agudo de miocardio eN Ancianos) randomized trial and pooled analysis with previous studies..
			    Eur Heart J 2010;:
					- 10.1093/eurheartj/ehq375
			    
 
				
					 
					Pubmed
				 	
				|
				
					Hubmed
				
				| Fulltext
		 
		
	 	
			 
			
			
			 
 |