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Prehospital thrombolysis for AMI to be studied in new clinical trial


Boehringer Ingelheim announced today that it is undertaking a new initiative in the treatment of heart attack (ST-segment elevation myocardial infarction or STEMI). The company will sponsor a new clinical trial known as STREAM (STrategic Reperfusion Early After Myocardial Infarction). In STREAM, the bolus thrombolytic agent tenecteplase (Metalyse®) will be administered prehospitally to patients presenting early (within 3 hours) after symptom onset.

“There are now several published reports suggesting that patients receiving lysis within two to three hours of symptom onset could have a lower mortality rate than patients undergoing a delayed primary percutaneous intervention (PCI),”1,2,3 said Professor Frans Van de Werf, chairman of the department of cardiology, University Hospital Gasthuisberg, Leuven, Belgium, and principal investigator of the STREAM trial.

“The STREAM trial will provide prospective randomized data that could support the concept of at least parity between prehospital lysis and primary PCI in early-presenting patients. And, because STREAM uses the most up-to-date regimen of adjunctive agents (clopidogrel and enoxaparin), we might also gain information that could be invaluable for future treatment algorithms,” Professor Van de Werf added. The announcement of the trial was made today during a satellite symposium held at the European Society of Cardiology congress in Vienna, Austria.

“Thrombolysis continues to be the most rapidly and most widely available form of treatment for many, if not most, of those who suffer a heart attack. STREAM is intended to consolidate existing data showing that prehospital thrombolysis is not ‘second-best’ medicine but, rather, can yield patient outcomes as good as – or even better than – those obtained with primary percutaneous intervention (PCI),” explained Dr. Manfred Haehl, Corporate Senior Vice President Medicine, Boehringer Ingelheim.


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