Effectiveness of tenecteplase versus streptokinase in treatment of acute myocardial infarction: a meta-analysis

Background: Thrombolytic therapy, an appropriate treatment option, if primary angioplasty is not available for the treatment of these patients in the early hours after the onset of the symptoms. The aim of this study was to evaluate the safety and effectiveness of new tenecteplase (TNKase) drug vs. streptokinase in the treatment of ST elevation myocardial infarction (STEMI) patients in Iran. Methods: A systematic review and meta-analysis that was conducted in Iran University of Medical Sciences in September 2017. We searched the MEDLINE, Cochrane Library (DARE-EED-HTA, Web of Science and EMBASE (1980 to March 2017) with number of strategies by the words “myocardial infarction, heart infarction, streptokinase, tenecteplase” in combination with other names of drugs and brands for clinical effectiveness. We hand searched US, European, and Iranian cardiovascular journals. Clinical trials and related observational studies in one of the Persian, English and Korean languages were included in this study. Two review authors independently assessed randomized controlled trials (RCTs) and non-RCT studies eligibility and quality, and extracted the data using data extraction form for interventions reviews. We cross-checked and resolved discrepancies by discussion to reach consensus. Finally, the data were entered to the Review Manager, Version 5.3 (The Nordic Cochrane Centre, Cochrane Collaboration, 2014, Copenhagen, Denmark), and then the Cochran-Mantel-Haenszel test (CMH) were used to analyzed the data. The I2 test has been used to calculate the Heterogeneity. Results: We included 4 observational studies. Observational study assessment by strengthening the reporting of observational studies in epidemiology (STROBE) checklist and quality was high described. All studies entered the final analysis after the quality assessment. All studies reported mortality. In the meta-analysis of mortality, three studies with a sample of 812 people entered. No difference was observed between tenecteplase and streptokinase in the risk of mortality (RR=0.45, CI 95%: 0.20-1.03, P=0.40), hypotension (RR=1.86, CI 95%: 0.53-6.49, P=0.33), bleeding (RR=1.40, CI 95%: 0.49-3.99, P=0.53), and no difference was observed in the ST Segment resolution >50% (P=0.81). Conclusion: The results of this study showed that the effectiveness and safety of streptokinase are similar to the tenecteplase drug.