Publication:

Comparative clinical effectiveness of thrombolytic agents streptokinase versus alteplase versus tenecteplase in the management of ST-segment elevation myocardial infarction: a systematic review and meta-analysis

ST-segment elevation myocardial infarction (STEMI) remains a leading cause of mortality worldwide, particularly in LMICs where access to primary percutaneous coronary intervention is limited. Thrombolytic therapy continues to be the cornerstone of reperfusion in such settings. This study aimed to assess the clinical effectiveness of fibrinolytic agents Streptokinase (SK), Alteplase (tPA), and Tenecteplase (TNK) in management of STEMI. This SRMA was conducted in accordance with the PRISMA guidelines. A literature search was performed across PubMed, Web of Science, and Embase using predefined keywords. Two independent reviewers screened titles, abstracts, and full texts. Data were extracted in predetermined way and assessed for quality using appropriate critical appraisal tools. Meta-analyses were performed using a random-effects model to compare the clinical outcomes. Total of 12 studies were selected out of 1280, 158 duplicates and 1048 studies were removed based on title and abstract screening, 59 studies were excluded on full text screening. Of all 9 evaluated vessel reperfusion based on TIMI grades, 8 evaluated 30-day mortality, 6 studies reported major bleeding events, 5 reported minor bleeding and 7 reported MACE. Meta-analysis showed significant improvement in reperfusion with fibrinolytic therapy (62.80%; 95% CI: 53.98–71.62%). TNK demonstrated higher reperfusion success and lower 30-day mortality (3.46%; 95% CI: 0.00- 7.85) compared to SK (5.15%; 95% CI 2.27- 8.04%). TNK exhibited the lowest bleeding risk (0.92; 95% CI: 0.03- 1.80%) and favourable MACE outcomes (11.04%, 95% CI: 3.44-18.64). Fibrin-specific thrombolytic i.e. TNK, demonstrate superior efficacy and safety in the management of STEMI.