Although primary PCI has emerged as the best treatment for STEMI, most patients don’t receive this treatment within the early time frame when it is known to be most beneficial. Delay in presentation is one important factor. Another is that most patients don’t arrive at a PCI-capable hospital and cannot be transferred fast enough to a PCI hospital.
The STREAM (Strategic Reperfusion Early after Myocardial Infarction) trial was planned as a proof-of-concept study to assess whether fibrinolysis was a beneficial alternative in this difficult group. Results were presented at the ACC in San Francisco and published simultaneously in the New England Journal of Medicine.