Acute ST-segment elevation myocardial infarction (STEMI) is a life-threatening condition where rapid reperfusion therapy is critical for improving patient outcomes. As a next-generation targeted thrombolytic agent, tenecteplase optimizes the structure of tissue-type plasminogen activator (t-PA), significantly extending its half-life, enhancing specificity, and improving resistance to PAI-1. These modifications result in superior thrombolytic speed, safety, and efficacy. Clinical studies demonstrate that intravenous tenecteplase effectively improves cardiac function, increases vascular recanalization rates, and reduces myocardial damage and bleeding risks in STEMI patients, outperforming urokinase and streptokinase. Additionally, intracoronary tenecteplase combined with emergency PCI shows promising potential in patients with high thrombus burden, effectively reducing thrombotic load, optimizing microcirculatory perfusion, and maintaining a favorable safety profile. However, current research is predominantly limited to small-scale or single-center trials, highlighting the need for larger, multicenter studies to further validate its therapeutic benefits. While intracoronary tenecteplase has not been widely adopted internationally, China’s domestically developed tenecteplase (Mingfule) has achieved positive clinical results. Future research should explore the broader potential of tenecteplase in STEMI treatment, particularly in combination therapies and personalized treatment strategies.
References
[1]
Tao, Q.F. and Xu, J.X. (2022) Research Progress in Clinical Treatment of Acute Myocardial Infarction. PopularScience&Technology, 24, 80-83.
[2]
Yeh, R.W., Sidney, S., Chandra, M., Sorel, M., Selby, J.V. and Go, A.S. (2010) Population Trends in the Incidence and Outcomes of Acute Myocardial Infarction. NewEnglandJournalofMedicine, 362, 2155-2165. https://doi.org/10.1056/nejmoa0908610
[3]
McManus, D.D., Gore, J., Yarzebski, J., Spencer, F., Lessard, D. and Goldberg, R.J. (2011) Recent Trends in the Incidence, Treatment, and Outcomes of Patients with STEMI and NSTEMI. TheAmericanJournalofMedicine, 124, 40-47. https://doi.org/10.1016/j.amjmed.2010.07.023
[4]
Myerson, M., Coady, S., Taylor, H., Rosamond, W.D. and Goff, D.C. (2009) Declining Severity of Myocardial Infarction from 1987 to 2002. Circulation, 119, 503-514. https://doi.org/10.1161/circulationaha.107.693879
[5]
Widimsky, P., Wijns, W., Fajadet, J., de Belder, M., Knot, J., Aaberge, L., etal. (2009) Reperfusion Therapy for ST Elevation Acute Myocardial Infarction in Europe: Description of the Current Situation in 30 Countries. EuropeanHeartJournal, 31, 943-957. https://doi.org/10.1093/eurheartj/ehp492
[6]
Fox, K.A.A., Steg, P.G., Eagle, K.A., Goodman, S.G., Anderson, F.A., Granger, C.B., etal. (2007) Decline in Rates of Death and Heart Failure in Acute Coronary Syndromes, 1999-2006. JAMA, 297, 1892-1900. https://doi.org/10.1001/jama.297.17.1892
[7]
Furman, M.I., Dauerman, H.L., Goldberg, R.J., Yarzbeski, J., Lessard, D. and Gore, J.M. (2001) Twenty-two Year (1975 to 1997) Trends in the Incidence, In-Hospital and Long-Term Case Fatality Rates from Initial Q-Wave and Non-Q-Wave Myocardial Infarction: A Multi-Hospital, Community-Wide Perspective. JournaloftheAmericanCollegeofCardiology, 37, 1571-1580. https://doi.org/10.1016/s0735-1097(01)01203-7
[8]
Mandelzweig, L. (2006) The Second Euro Heart Survey on Acute Coronary Syndromes: Characteristics, Treatment, and Outcome of Patients with ACS in Europe and the Mediterranean Basin in 2004. EuropeanHeartJournal, 27, 2285-2293. https://doi.org/10.1093/eurheartj/ehl196
[9]
Liew, R. (2006) Declining Case Fatality Rates for Acute Myocardial Infarction in South Asian and White Patients in the Past 15 Years. Heart, 92, 1030-1034. https://doi.org/10.1136/hrt.2005.078634
[10]
Ibanez, B., James, S., Agewall, S., Antunes, M.J., Bucciarelli-Ducci, C., Bueno, H., etal. (2017) 2017 ESC Guidelines for the Management of Acute Myocardial Infarction in Patients Presenting with St-Segment Elevation. EuropeanHeartJournal, 39, 119-177. https://doi.org/10.1093/eurheartj/ehx393
[11]
Rosselló, X., Huo, Y., Pocock, S., Van de Werf, F., Chin, C.T., Danchin, N., etal. (2017) Global Geographical Variations in ST-Segment Elevation Myocardial Infarction Management and Post-Discharge Mortality. InternationalJournalofCardiology, 245, 27-34. https://doi.org/10.1016/j.ijcard.2017.07.039
[12]
Li, J., Li, X., Wang, Q., Hu, S., Wang, Y., Masoudi, F.A., etal. (2015) ST-Segment Elevation Myocardial Infarction in China from 2001 to 2011 (the China Peace-Retrospective Acute Myocardial Infarction Study): A Retrospective Analysis of Hospital Data. TheLancet, 385, 441-451. https://doi.org/10.1016/s0140-6736(14)60921-1
[13]
O'Gara, P.T., Kushner, F.G., Ascheim, D.D., Casey, D.E., Chung, M.K., de Lemos, J.A., etal. (2013) 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: Executive Summary. JournaloftheAmericanCollegeofCardiology, 61, 485-510. https://doi.org/10.1016/j.jacc.2012.11.018
[14]
Access Investigators (2011) Management of Acute Coronary Syndromes in Developing Countries: Acute Coronary Events—A Multinational Survey of Current Management Strategies. American Heart Journal, 162, 852-859.e22.
[15]
Keeley, E.C., Boura, J.A. and Grines, C.L. (2003) Primary Angioplasty versus Intravenous Thrombolytic Therapy for Acute Myocardial Infarction: A Quantitative Review of 23 Randomised Trials. TheLancet, 361, 13-20. https://doi.org/10.1016/s0140-6736(03)12113-7
[16]
Gibson, C.M., Kumar, V., Gopalakrishnan, L., Singh, P., Guo, J., Kazziha, S., et al. (2020) Feasibility and Safety of Low-Dose Intra-Coronary Tenecteplase during Primary Percutaneous Coronary Intervention for St-Elevation Myocardial Infarction (ICE T-TIMI 49). TheAmericanJournalofCardiology, 125, 485-490. https://doi.org/10.1016/j.amjcard.2019.11.018
[17]
Expert Committee on Rational Drug Use of National Health and Family Planning Commission and Chinese Pharmacists Association (2019) Guidelines for Rational Drug Use in Thrombolytic Therapy for Acute ST-Segment Elevation Myocardial Infarction (2nd Edition). ChineseJournaloftheFrontiersofMedicalScience (ElectronicVersion), 11, 40-65.
[18]
Chinese Society of Cardiology and Editorial Board of Chinese Journal of Cardiology (2019) Guidelines for the Diagnosis and Treatment of Acute ST-Segment Elevation Myocardial Infarction (2019). ChineseJournalofCardiology, 47, 766-783.
[19]
Liu, C., Zhang, K., Zhang, S., Li, X., Sun, H. and Ma, L. (2024) Maggot Kinase and Natural Thrombolytic Proteins. ACSOmega, 9, 21768-21779. https://doi.org/10.1021/acsomega.4c01663
[20]
Miller, S.E. and Warach, S.J. (2023) Evolving Thrombolytics: From Alteplase to Tenecteplase. Neurotherapeutics, 20, 664-678. https://doi.org/10.1007/s13311-023-01391-3
[21]
Tanswell, P., Modi, N., Combs, D. and Danays, T. (2002) Pharmacokinetics and Pharmacodynamics of Tenecteplase in Fibrinolytic Therapy of Acute Myocardial Infarction. ClinicalPharmacokinetics, 41, 1229-1245. https://doi.org/10.2165/00003088-200241150-00001
[22]
Tsivgoulis, G., Kargiotis, O., De Marchis, G., Kohrmann, M., Sandset, E.C., Karapanayiotides, T., etal. (2021) Off-label Use of Intravenous Thrombolysis for Acute Ischemic Stroke: A Critical Appraisal of Randomized and Real-World Evidence. Therapeutic Advances in Neurological Disorders, 14, 1-29. https://doi.org/10.1177/1756286421997368
[23]
Thiebaut, A.M., Gauberti, M., Ali, C., Martinez De Lizarrondo, S., Vivien, D., Yepes, M., et al. (2018) The Role of Plasminogen Activators in Stroke Treatment: Fibrinolysis and Beyond. TheLancetNeurology, 17, 1121-1132. https://doi.org/10.1016/s1474-4422(18)30323-5
[24]
Morales-Ponce, F.J., Lozano-Cid, F.J., Martinez-Romero, P., Gonzalez-Perez, P., Sanchez-Brotons, J.A., Diaz-Torres, I., et al. (2019) Intracoronary Tenecteplase versus Abciximab as Adjunctive Treatment during Primary Percutaneous Coronary Intervention in Patients with Anterior Myocardial Infarction. EuroIntervention, 14, 1668-1675. https://doi.org/10.4244/eij-d-18-00885
[25]
Li, Y., Cui, R., Fan, F., Lu, Y., Ai, Y., Liu, H., etal. (2022) The Efficacy and Safety of Ischemic Stroke Therapies: An Umbrella Review. FrontiersinPharmacology, 13, Article 924747. https://doi.org/10.3389/fphar.2022.924747
[26]
Xiong, Y., Wakhloo, A.K. and Fisher, M. (2022) Advances in Acute Ischemic Stroke Therapy. CirculationResearch, 130, 1230-1251. https://doi.org/10.1161/circresaha.121.319948
[27]
Frank, D., Zlotnik, A., Boyko, M. and Gruenbaum, B.F. (2022) The Development of Novel Drug Treatments for Stroke Patients: A Review. InternationalJournalofMolecularSciences, 23, Article 5796. https://doi.org/10.3390/ijms23105796
[28]
Warach, S.J., Dula, A.N. and Milling, T.J. (2020) Tenecteplase Thrombolysis for Acute Ischemic Stroke. Stroke, 51, 3440-3451. https://doi.org/10.1161/strokeaha.120.029749
[29]
Assessment of the Safety and Efficacy of a New Treatment Strategy with Percutaneous Coronary Intervention (ASSENT-4 PCI) Investigators (2006) Primary versus Tenecteplase-Facilitated Percutaneous Coronary Intervention in Patients with ST-Segment Elevation Acute Myocardial Infarction (ASSENT-4 PCI): Randomised Trial. Lancet, 367, 569-578.
[30]
Benedict, C.R., Refino, C.J., Keyt, B.A., Pakala, R., Paoni, N.F., Thomas, G.R., etal. (1995) New Variant of Human Tissue Plasminogen Activator (TPA) with Enhanced Efficacy and Lower Incidence of Bleeding Compared with Recombinant Human TPA. Circulation, 92, 3032-3040. https://doi.org/10.1161/01.cir.92.10.3032
[31]
Wang, J.Y., Li, R.C. and Chen, H.J. (2021) Evaluation of the Efficacy and Safety of Tenecteplase Thrombolysis in Patients with Acute ST-Segment Elevation Myocardial Infarction. NorthernPharmacy, 18, 164-165.
[32]
He, Y.S. (2024) Effects of Recombinant Human TNK Tissue-Type Plasminogen Activator Intravenous Thrombolysis on Cardiac Function and Vascular Recanalization Rate in Patients with Early Acute ST-Segment Elevation Myocardial Infarction. NorthernPharmacy, 21, 54-56.
[33]
Huang, Y.X., Liang, L., Huang, Z.Q., et al. (2023) Clinical Application Effect of Te-necteplase Intravenous Thrombolysis in Acute ST-Segment Elevation Myocardial Infarction. ModernMedicineandHealthResearch, 7, 142-144.
[34]
Bawaskar, H., Bawaskar, P. and Bawaskar, P. (2019) Preintensive Care: Thrombolytic (Streptokinase or Tenecteplase) in ST Elevated Acute Myocardial Infarction at Peripheral Hospital. JournalofFamilyMedicineandPrimaryCare, 8, 62-71. https://doi.org/10.4103/jfmpc.jfmpc_297_18
[35]
Zheng, C.X., Li, W.W. and Lin, Y.Z. (2023) Efficacy of Tenecteplase Versus Urokinase in Acute ST-Segment Elevation Myocardial Infarction and Their Effects on Myocardial Injury Markers. JournalofMedicalTheoryandPractice, 36, 942-944.
[36]
He, L.Y. (2023) Clinical Study of Intracoronary Injection of Tenecteplase during Emergency PCI in Patients with Acute Myocardial Infarction and High Thrombus Burden. KnowledgeofCardiovascularDiseasePreventionandTreatment, 13, 22-25.
[37]
Wang, H., Yang, N., Liu, Y.W., etal. (2024) Effects of Intracoronary Injection of Recombinant Human TNK Tissue-Type Plasminogen Activator on Microcirculation in Elderly Patients with Myocardial Infarction. ChineseJournalofGeriatricHeartBrainandVesselDiseases, 26, 857-861.
[38]
Jayagopal, P.B. and Sarjun Basha, K.M. (2018) Intracoronary Tenecteplase in STEMI with Massive Thrombus. IndianHeartJournal, 70, 446-449. https://doi.org/10.1016/j.ihj.2017.08.016
[39]
Windecker, S., Kolh, P. and Alfonso, F. (2014) 2014 ESC/EACTS Guidelines on Myocardial Revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the Special Contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). European Heart Journal, 35, 2541-2619. https://doi.org/10.1093/eurheartj/ehu278
