Disclosures The authors have no conﬂicts of interest to disclose. References 1. Antman EM, Hand M, Armstrong PW, et al. 2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: Developed in Collaboration With the Canadian Cardiovascular Society Endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee. Circulation. 2008;117:296–329. 2. Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intrave- nous thrombolytic therapy for acute myocardial infarction: a quantita- tive review of 23 randomised trials. Lancet. 2003;361:13–20. 3. Melandri G. Primary angioplasty or thrombolysis for acute myocardial infarction? Lancet. 2003;361:966; author reply 967–968. 4. DeMaria AN. Lies, damned lies, and statistics. J Am Coll Cardiol. 2008; 52:1430–1431. 5. Boden WE, Eagle K, Granger CB. Reperfusion Strategies in Acute ST-Segment Elevation Myocardial Infarction: A Comprehensive Review of Contemporary Management Options J Am Coll Cardiol. 2007;50:917–929. 6. Nallamothu BK, Bates ER, Herrin J, Wang Y, Bradley EH, Krumholz HM. Times to treatment in transfer patients undergoing primary percutane- ous coronary intervention in the United States: National Registry of Myocardial Infarction (NRMI)-3/4 analysis. Circulation. 2005; 111:761–767. 7. Jollis JG, Roettig ML, Aluko AO, et al; the Reperfusion of Acute Myocardial Infarction in North Carolina Emergency Departments (RACE) Investigators. Implementation of a Statewide System for Coronary Reperfusion for ST-Segment Elevation Myocardial Infarction. JAMA. 2007;298:2371–2380. 8. Vakili BA, Kaplan R, Brown DL. Volume-outcome relation for physicians and hospitals performing angioplasty for acute myocardial infarction in New York state. Circulation. 2001;104:2171–2176. 9. Bonnefoy E, Lapostolle F, Leizorovicz A, et al. Primary angio- plasty versus prehospital ﬁbrinolysis in acute myocardial infarction: a randomised study. Lancet. 2002;360:825–829. 10. Gale CP, Manda SOM, Batin PD, Weston CF, Birkhead JS, Hall AS. Predictors of in-hospital mortality for patients admitted with ST-elevation myocardial infarction: a real-world study using the Myocardial Infarction National Audit Project (MINAP) database. Heart. 2008;94:1407–1412. 11. Pinto DS, Kirtane AJ, Nallamothu BK, et al. Hospital delays in reperfu- sion for ST-elevation myocardial infarction: implications when selecting a reperfusion strategy. Circulation. 2006;114:2019–2025. 12. Bates ER, Nallamothu BK. Commentary: the role of percutaneous coronary intervention in ST-segment-elevation myocardial infarction. Circulation. 2008;118:567–573. 13. Manari A, Ortolani P, Guastaroba P, et al. Clinical impact of an inter- hospital transfer strategy in patients with ST-elevation myocardial infarction undergoing primary angioplasty: the Emilia-Romagna ST- segment elevation acute myocardial infarction network. Eur Heart J. 2008;29:1834–1842. 14. Sabatine MS, Cannon CP, Gibson CM, et al; the CLARITY-TIMI 28 Investigators. Addition of Clopidogrel to Aspirin and Fibrinolytic Therapy for Myocardial Infarction with ST-Segment Elevation. N Engl J Med. 2005;352:1179–1189. 15. Antman EM, Morrow DA, McCabe CH, et al; the ExTRACT-TIMI 25 Investigators. Enoxaparin versus Unfractionated Heparin with Fibrinolysis for ST-Elevation Myocardial Infarction. N Engl J Med. 2006;354:1477–1488. Vascular Health and Risk Management 2009:5 TNKase in acute myocardial infarction 16. Tsikouris JP, Tsikouris AP. A review of available ﬁbrin-speciﬁc thrombolytic agents used in acute myocardial infarction. Pharmaco- therapy. 2001;21:207–217. 17. Modi NB, Eppler S, Breed J, Cannon CP, Braunwald E, Love TW. Pharmacokinetics of a slower clearing tissue plasminogen activator variant, TNK-tPA, in patients with acute myocardial infarction. Thromb Haemost. 1998;79:134–139. 18. Serebruany V, Malinin A, Callahan K, et al. Effect of tenecteplase versus alteplase on platelets during the ﬁrst 3 hours of treatment for acute myocardial infarction: The Assessment of the Safety and Efﬁcacy of a New Thrombolytic Agent (ASSENT-2) platelet substudy. Am Heart J. 2003;145:636–642. 19. Collen D, Stassen JM, Yasuda T, et al. Comparative thrombolytic properties of tissue-type plasminogen activator and of a plasminogen activator inhibitor-1-resistant glycosylation variant, in a combined arterial and venous thrombosis model in the dog. Thromb Haemost. 1994;72:98–104. 20. Cannon CP, McCabe CH, Gibson CM, et al. TNK-tissue plasminogen activator in acute myocardial infarction. Results of the Thrombolysis in Myocardial Infarction (TIMI) 10A dose-ranging trial. Circulation. 1997;95:351–356. 21. Cannon CP, Gibson CM, McCabe CH, et al. TNK-tissue plasminogen activator compared with front-loaded alteplase in acute myocardial infarction: results of the TIMI 10B trial. Thrombolysis in Myocardial Infarction (TIMI) 10B Investigators. Circulation. 1998;98:2805–2814. 22. Van de Werf F, Cannon CP, Luyten A, Houbracken K, McCabe CH, Berioli S, et al. Safety assessment of single-bolus administration of TNK tissue-plasminogen activator in acute myocardial infarction: the ASSENT- 1 trial. The ASSENT-1 Investigators. Am Heart J. 1999;137:786–91. 23. Giugliano RP, McCabe CH, Antman EM, Cannon CP, Van de Werf F, Wilcox RG, et al. Lower-dose heparin with ﬁbrinolysis is associated with lower rates of intracranial hemorrhage. Am Heart J. 2001;141:742–750. 24. Single-bolus tenecteplase compared with front-loaded alteplase in acute myocardial infarction: the ASSENT-2 double-blind randomised trial. Assessment of the Safety and Efﬁcacy of a New Thrombolytic Investigators. Lancet. 1999;354:716–722. 25. Van de Werf F, Barron HV, Armstrong PW, et al. Incidence and predictors of bleeding events after ﬁbrinolytic therapy with ﬁbrin- speciﬁc agents: a comparison of TNK-tPA and rt-PA. Eur Heart J. 2001;22:2253–2261. 26. Sinnaeve PA, Alexander JB, Belmans AC, et al. One-year follow-up of the ASSENT-2 trial: A double-blind, randomized comparison of single- bolus tenecteplase and front-loaded alteplase in 16,949 patients with ST- elevation acute myocardial infarction. Am Heart J. 2003;146:27–32. 27. Assessment of the Safety and Efﬁcacy of a New Thrombolytic Regi- men (ASSENT)-3 Investigators. Efﬁcacy and safety of tenecteplase in combination with enoxaparin, abciximab, or unfractionated heparin: the ASSENT-3 randomised trial in acute myocardial infarction. Lancet. 2001;358:605–613. 28. Antman EM, Louwerenburg HW, Baars HF, et al; the ENTIRE-TIMI 23 Investigators. Enoxaparin as Adjunctive Antithrombin Therapy for ST-Elevation Myocardial Infarction: Results of the ENTIRE- Thrombolysis in Myocardial Infarction (TIMI) 23 Trial. Circulation. 2002;105:1642–1649. 29. Kaul P, Armstrong PW, Cowper PA, et al. Economic analysis of the Assessment of the Safety and Efﬁcacy of a New Thrombolytic Regimen (ASSENT-3) study: costs of reperfusion strategies in acute myocardial infarction. Am Heart J. 2005;149:637–644. 30. Giugliano RP, Roe MT, Harrington RA, et al. Combination reperfusion therapy with eptiﬁbatide and reduced-dose tenecteplase for ST-elevation myocardial infarction: Results of the integrilin and tenecteplase in acute myocardial infarction (INTEGRITI) Phase II Angiographic urial. J Am Coll Cardiol. 2003;41:1251–1260. 31. Topol EJ. Reperfusion therapy for acute myocardial infarction with ﬁbrinolytic therapy or combination reduced ﬁbrinolytic therapy and platelet glycoprotein IIb/IIIa inhibition: the GUSTO V randomised trial. Lancet. 2001;357:1905–1914. 255