STEPP-AMI compared the efficacy and safety of a pharmaco-invasive strategy versus PCI in Indian STEMI patients <75 years of age, presenting within 12 h of symptom onset

Study design

A prospective, observational, multi-centre pilot study with 1-year follow-up. Patients could choose between:

  • Group A (n=45): TNK + immediate rescue PPI upon failed thrombolysis
  • Group B (n=155): PPCI

Primary endpoint

Composite of death, cardiogenic shock, re-infarction, repeat revascularisation of culprit artery and congestive heart failure at 30 days

STEPP-AMI: primary endpoint*

Kaplan-Meier curves for the primary endpoint


  • There was a trend towards benefit for PPCI, especially during the early phase of follow-up, but significance was not reached.
  • Even though PPCI remains the preferred treatment option, a pharmaco-invasive strategy can be implemented safely in patients <75 years who do not undergo PPCI in India.
  • In a developing country like India, pharmaco-invasive strategy may successfully alleviate the logistic or geographical barriers of PPCI in the treatment of AMI.
  • Given the limited sample size, these findings require additional investigation.
  1. Victor SM, et al. A prospective, observational, multicentre study comparing tenecteplase facilitated PCI versus primary PCI in Indian patients with STEMI (STEP-AMI). Open Heart 2014;1(1):e000133.