Principal Findings:

There were significantly fewer efficacy endpoints (composites of 30-day mortality, in-hospital reinfarction, or in-hospital refractory ischemia) in the enoxaparin and abciximab groups than in the UFH group: 233/2,037 (11.4%) vs. 315/2,038 (15.4%; relative risk 0.74 [95% confidence interval 0.63-0.87], p=0.0002) for enoxaparin and 223/2,017 (11.1%) vs. 315/2,038 (15.4%; 0.72 [0.61-0.84], p<0.0001) for abciximab. Similarly, the efficacy plus safety endpoint (in-hospital intracranial hemorrhage or in-hospital major bleeding complications) were significantly lower for the enoxaparin group, and trended to be lower in the abciximab group compared with the UFH group: 280/2,037 (13.7%) vs. 347/2,036 (17.0%; 0.81 [0.70-0.93], p=0.0146) for enoxaparin, and 287/2016 (14.2%) vs. 347/2036 (17.0%; 0.84 [0.72-0.96], p=0.057) for abciximab.

Among patients over the age of 75, the risk of the composite endpoint of efficacy and safety was worse in the abciximab group compared to the heparin group: 36.9% versus 28.0% (p=0.001), but not in the enoxaparin group (25.5%). Likewise, among diabetics, the risk of the composite endpoint of efficacy and safety was worse in the abciximab group relative to the heparin group: 22.3% versus 16.5%, p=0.0007, but not in the enoxaparin group (13.9%). The rates of major hemmorrhage were increased in the abciximab group relative to the heparin group (4.3% vs. 2.2%, p=0.0002), but were not increased significantly in the enoxaparin group (3.0%, p=NS vs. heparin). Thirty-day mortality was lowest in the enoxaparin group (5.4%), and is the lowest in a major thrombolytic trial reported to date.

The tenecteplase plus enoxaparin or abciximab regimens reduce the frequency of ischemic complications in AMI patients. Tenecteplase plus enoxaparin seems to be an attractive alternative reperfusion regimen because of the simplicity of administration, and warrants further study.