Time is the key to survival: A case report on the timely use of tenecteplase for the treatment of acute stemi

Abstract

Coronary thrombosis disrupts plaque, leading to acute myocardial infarction with ST segment elevation (STEMI). Time to reperfusion is a significant predictor of mortality in STEMI events.1 The average duration from symptom onset to the beginning of pharmacological reperfusion therapy is 2.5 to 3 hours.2 The American College of Cardiology and the American Heart Association recommend pre-hospital thrombolysis treatment be completed within 30 minutes and 12-lead ECG recorded "on-scene".3

Tenecteplase (brand Elaxim) injection, comprises the alteplase molecule, except for three point mutations, with the highest fibrin specificity and binding and extended plasma half life. Plasminogen activator inhibitor-1 (PAI-1) inhibition is 80 times lower than alteplase.4 Tenecteplase has three times greater thrombolytic potency than alteplase in vivo, making it an intriguing treatment for individuals with STEMI.5 Tenecteplase provides a single bolus infusion. We, hereby report a case of inferior wall acute STEMI treated with Tenecteplase 30 to 60 minutes from symptom onset.