Tenecteplase vs Reteplase in Patients with Acute ST-Elevation Myocardial Infarction: A Retrospective Cohort Study

Coronary artery disease is one of the leading causes of death globally. Despite the increased number of percutaneous coronary intervention (PCI) capable facilities, fibrinolytic therapy is still being utilized especially in rural areas. No studies have directly compared tenecteplase and reteplase in patients with ST-elevation myocardial infarction (STEMI).Purpose The aim of this study is to compare the efficacy and safety of both agents in patients with acute STEMI.Methods This was a multicenter retrospective observational study comparing tenecteplase and reteplase in patients with acute STEMI. The primary outcome was the incidence of failed thrombolysis. Secondary outcomes included the incidence of major bleeding, cardiogenic shock, re-infarction and mortality.Results A total of 282 patients were included, 229 and 53 received tenecteplase and reteplase, respectively. The incidence of failed thrombolysis was 33.2% in the tenecteplase group compared to 20.8% in the reteplase group (adjusted odds ratio 0.53, 95% confidence interval 0.25-1.1; p = 0.089). The incidence of major bleeding was 0.9% in the tenecteplase group and 5.7% in the reteplase group (p = 0.017). There was no significant difference in mortality or other secondary outcomes.Conclusion There was no difference in the primary outcome of failed thrombolysis between tenecteplase and reteplase; however, major bleeding events were significantly higher in the reteplase group. Randomized controlled trials are needed to confirm our findings.