Adjunctive, Low-dose tPA in Primary PCI for STEMI
Adjunctive, Low-dose tPA in Primary PCI for STEMI
STRIVE will evaluate the use of adjunctive, low-dose intracoronary tissue plasminogen
 activator during primary percutaneous coronary intervention (PCI) for patients with ST
 elevation myocardial infarction (STEMI) in reducing the incidence of post-procedural
 myocardial blush (MBG) grade 0/1 or distal embolization.
STRIVE is a prospective, 3-arm, parallel group, blinded, randomized controlled trial
 evaluating the efficacy of a novel approach to prevent and treat microvascular obstruction
 thereby reducing major cardiovascular events using intracoronary administration of very
 low-dose fibrinolytic (tissue plasminogen activator, tPA) directly into the culprit coronary
 artery during primary PCI.
Inclusion Criteria:

 1. Patients with STEMI undergoing primary PCI and,

 2. ECG changes indicating large territory STEMI (defined as ≥2mm ST-segment elevation in
 2 contiguous anterior precordial leads; or ≥2mm ST-segment elevation in 2 inferior
 leads coupled with ST-segment depression in 2 contiguous anterior leads for a total
 ST-segment deviation of ≥8mm) and,

 3. Randomization within 6 to 12 hours of symptom onset and,

 4. Large thrombus burden with angiographic TIMI Thrombus Grade ≥3 after guidewire
 crossing.

 Exclusion Criteria:

 1. Active internal bleeding or high risk of bleeding or any prior intracranial bleeding.

 2. Any other absolute or relative contraindication to fibrinolytic therapy.

 3. Administration of a fibrinolytic ≤24hrs prior to randomization.

 4. Cardiogenic shock on presentation.

 5. Left bundle branch block (excluded because the ECG cannot be evaluated for ST segment
 resolution, an outcome of the study).

 6. Planned upfront use of a glycoprotein IIb/IIIa inhibitor.

 7. Any medical, geographic, or social factor making study participation impractical or
 precluding 1 month follow-up.