Single Bolus Recombinant Nonimmunogenic Staphylokinase Versus Single Bolus Tenecteplase (Metalyse) in STEMI

Inclusion Criteria

• both gender patients over 18 years
• 12-lead ECG indicative of an STEMI (ST-segment elevation in acute myocardial infarction, measured at the J point, should be found in two contiguous leads and be ≥0.25 mV in men below the age of 40 years, ≥0.2 mV in men over the age of 40 years, or ≥0.15 mV in women in leads V2-V3 and/or ≥0.1 mV in other leads (in the absence of left ventricular hypertrophy or left bundle branch block
• the possibility of fibrinolysis within 12 hour of symptom onset
• inability of primary PCI within 60 min of first medical contact (FMC)
• informed consent received

Exclusion Criteria

• expected performance of PCI less 60 min from FMC
• left bundle branch block or ventricular pacing
• cases of sinus bradycardia associated with hypotension, AV block II (Mobitz 2) or AV block III with bradycardia that causes hypotension or heart failure
• active bleeding or known bleeding disorders/diathesis
• uncontrolled hypertension, defined us single blood pressure measurement ≥180/110 mm Hg prior to randomization
• internal bleeding within the past 2 weeks
• conditions with increased risk of bleeding (peptic ulceration)
• prolonged or traumatic resuscitation within the past 2 weeks
• any known history of hemorrhagic stroke, or transitory ischemic attack
• ischemic stroke within the past 3 month
• puncture of unpressable vessels
• aortic aneurism
• intracranial neoplasm
• any head trauma within past 2 weeks
• intracranial vessel malformation
• recent administration of anticoagulant within the past month
• INR >1.3
• sensibilisation to staphylokinase
• contra-indications to acetylsalicilic acid, clopidogrel, enoxaparin
• any conditions with unfavorable prognosis
• in case of surgical treatment required within 30 days after randomization
• in case of unhallowed medications required
• pregnancy, lactation
• inability to follow the protocol