From the Guidelines

Retavase (Reteplase) trials in STEMI have shown that immediate or early stenting after fibrinolysis reduces mortality and reinfarction rates.

The Leipzig Prehospital Fibrinolysis Group trial found that immediate PCI after reteplase plus abciximab reduced infarct size and tended to reduce the composite clinical end point of death, reinfarction, major bleeding, or stroke at 6 months 1.
The Southwest German Interventional Study in Acute Myocardial Infarction (SIAM III) trial showed that early stenting after reteplase resulted in a reduction in the primary 6-month composite end point of death, reinfarction, target lesion revascularization, and recurrent ischemic events 1.
The Combined Abciximab Reteplase Stent Study in Acute MI (CARESS-AMI) trial demonstrated that urgent transfer for immediate catheterization after half-dose reteplase and abciximab reduced the primary composite end point of death, reinfarction, or refractory myocardial ischemia within 30 days of randomization 1.

CARESS-AMI trial: 600 STEMI patients were randomized to immediate transfer for PCI or standard treatment with transfer for rescue PCI if needed, showing improved outcomes with immediate PCI 1.
SIAM III trial: 163 STEMI patients were randomized to urgent stenting or elective stenting after 2 weeks, demonstrating a reduction in the primary 6-month composite end point with early stenting 1.
Leipzig Prehospital Fibrinolysis Group trial: 164 patients were randomized to reteplase plus abciximab alone or reteplase plus abciximab and transfer for immediate PCI, showing reduced infarct size and improved clinical outcomes with immediate PCI 1.

These trials support the use of immediate or early stenting after fibrinolysis with reteplase in STEMI patients, particularly those at high risk or with evidence of failed reperfusion 1.
The results of these trials have informed the development of guidelines for the management of STEMI patients, including the recommendation for rescue PCI in patients with high-risk criteria or evidence of failed reperfusion 1.

From the Research

The efficacy and safety of reteplase in patients with ST-segment elevation myocardial infarction (STEMI) have been evaluated in several clinical trials 2, 3, 4, 5, 6.
Reteplase has been shown to be effective in achieving coronary artery patency and reducing the time to treatment in patients with STEMI 2, 3, 5.
The RAPID-II study demonstrated that double-bolus administration of reteplase 10U + 10U produced significantly higher coronary artery patency rates than accelerated alteplase in patients with AMI 5.
The INJECT study showed that the 10U + 10U reteplase regimen produced a 35-day survival rate at least equivalent to that seen with a 1-hour infusion of streptokinase 1.5 million units in 5986 patients with STEMI 5.
A multicenter clinical trial conducted in China found that reteplase use was related to high recanalization rate and low cardiovascular events and bleeding rate in patients with STEMI 4.
A systematic review and network meta-analysis of randomized controlled trials comparing fibrinolytic drugs in patients with STEMI found that reteplase was associated with a similar risk of all-cause mortality and major bleeding compared to accelerated infusion of alteplase and tenecteplase 6.

Reteplase is a valuable option for pre- or in-hospital thrombolytic treatment in patients with STEMI due to its efficacy and ease of administration 2, 3.
The incidence of bleeding complications associated with reteplase treatment appears to be similar to that associated with other thrombolytic agents 2, 3, 5.
The addition of glycoprotein IIb or IIIa inhibitors to fibrinolytic therapy with reteplase increases the risk of major bleeding 6.