1. Expected performance of PCI < 60 minutes from diagnosis (qualifying ECG) or inability to arrive at the catheterisation laboratory within 3 hours
Previous CABG
Left bundle branch block or ventricular pacing
Patients with cardiogenic shock - Killip Class 4
Patients with a body weight < 55 kg (known or estimated)
Uncontrolled hypertension, defined as sustained blood pressure = 180/110 mm Hg (systolic BP = 180 mm Hg and/or diastolic BP = 110 mm Hg) prior to randomisation
Known prior stroke or TIA
Recent administration of any i.v. or s.c. anticoagulation within 12 hours, including unfractionated heparin, enoxaparin, and/or bivalirudin or current use of oral anticoagulation (i.e. warfarin or a NOACs)
Active bleeding or known bleeding disorder/diathesis
Known history of central nervous system damage (i.e. neoplasm, aneurysm, intracranial or spinal surgery) or recent trauma to the head or cranium (i.e. < 3 months)
Major surgery, biopsy of a parenchymal organ, or significant trauma within the past 2 months (this includes any trauma associated with the current myocardial infarction)
Clinical diagnosis associated with increased risk of bleeding including known active peptic ulceration and/or neoplasm with increased bleeding risk
Prolonged cardiopulmonary resuscitation (> 2 minutes) within the past 2 weeks
Known acute pericarditis and/or subacute bacterial endocarditis
Known acute pancreatitis or known severe hepatic dysfunction, including hepatic failure, cirrhosis, portal hypertension (oesophageal varices) and active hepatitis
Dementia
Known severe renal insufficiency
Previous enrolment in this study or treatment with an investigational drug or device under another study protocol in the past 7 days
Known allergic reactions to tenecteplase, clopidogrel, enoxaparin and aspirin
Inability to follow the protocol and comply with follow-up requirements or any other reason that the investigator feels would place the patient at increased risk if the investigational therapy is initiated.

NCT02777580_exc_T1
Device
PCI
NCT02777580_exc_T2
Temporal
< 60 minutes from diagnosis
NCT02777580_exc_T3
Reference_point
diagnosis
NCT02777580_exc_T5
Procedure
CABG
NCT02777580_exc_T6
Condition
Left bundle branch block
NCT02777580_exc_T7
Condition
ventricular pacing
NCT02777580_exc_T8
Condition
cardiogenic shock
NCT02777580_exc_T9
Measurement
Killip Class
NCT02777580_exc_T10
Value
4
NCT02777580_exc_T11
Measurement
body weight
NCT02777580_exc_T12
Value
< 55 kg
NCT02777580_exc_T13
Condition
hypertension
NCT02777580_exc_T14
Qualifier
Uncontrolled
NCT02777580_exc_T15
Measurement
blood pressure
NCT02777580_exc_T16
Value
= 180/110 mm Hg
NCT02777580_exc_T17
Measurement
systolic BP
NCT02777580_exc_T18
Value
= 180 mm Hg
NCT02777580_exc_T19
Measurement
diastolic BP
NCT02777580_exc_T20
Value
= 110 mm Hg
NCT02777580_exc_T21
Scope
systolic BP = 180 mm Hg and/or diastolic BP = 110 mm Hg
NCT02777580_exc_T22
Condition
stroke
NCT02777580_exc_T23
Condition
TIA
NCT02777580_exc_T24
Drug
anticoagulation
NCT02777580_exc_T25
Temporal
within 12 hours
NCT02777580_exc_T26
Drug
unfractionated heparin
NCT02777580_exc_T27
Drug
enoxaparin
NCT02777580_exc_T28
Drug
bivalirudin
NCT02777580_exc_T29
Drug
oral anticoagulation
NCT02777580_exc_T30
Drug
warfarin
NCT02777580_exc_T31
Drug
NOACs
NCT02777580_exc_T32
Scope
unfractionated heparin, enoxaparin, and/or bivalirudin or current use of oral anticoagulation (i.e. warfarin or a NOACs)
NCT02777580_exc_T33
Scope
warfarin or a NOACs
NCT02777580_exc_T34
Condition
Active bleeding
NCT02777580_exc_T35
Condition
bleeding disorder
NCT02777580_exc_T36
Condition
diathesis
NCT02777580_exc_T37
Condition
central nervous system damage
NCT02777580_exc_T38
Condition
neoplasm
NCT02777580_exc_T39
Condition
aneurysm
NCT02777580_exc_T40
Procedure
ial or spina or rece
NCT02777580_exc_T41
Procedure
spinal surgery
NCT02777580_exc_T42
Scope
neoplasm, aneurysm, intracranial or spinal surgery
NCT02777580_exc_T43
Condition
trauma
NCT02777580_exc_T44
Qualifier
head
NCT02777580_exc_T45
Qualifier
cranium
NCT02777580_exc_T46
Temporal
< 3 months
NCT02777580_exc_T47
Scope
head or cranium
NCT02777580_exc_T48
Procedure
Major surgery
NCT02777580_exc_T49
Procedure
biopsy
NCT02777580_exc_T50
Qualifier
parenchymal organ
NCT02777580_exc_T51
Condition
trauma
NCT02777580_exc_T52
Qualifier
significant
NCT02777580_exc_T53
Temporal
past 2 months
NCT02777580_exc_T54
Scope
Major surgery, biopsy of a parenchymal organ, or significant trauma
NCT02777580_exc_T55
Condition
myocardial infarction
NCT02777580_exc_T56
Observation
risk of bleeding
NCT02777580_exc_T57
Qualifier
increased
NCT02777580_exc_T58
Condition
peptic ulceration
NCT02777580_exc_T59
Qualifier
active
NCT02777580_exc_T60
Condition
neoplasm
NCT02777580_exc_T61
Scope
active peptic ulceration and/or neoplasm
NCT02777580_exc_T62
Condition
cardiopulmonary resuscitation
NCT02777580_exc_T63
Qualifier
Prolonged
NCT02777580_exc_T64
Temporal
past 2 weeks
NCT02777580_exc_T65
Condition
acute pericarditis
NCT02777580_exc_T66
Condition
subacute bacterial endocarditis
NCT02777580_exc_T67
Condition
acute pancreatitis
NCT02777580_exc_T68
Condition
hepatic dysfunction
NCT02777580_exc_T69
Qualifier
severe
NCT02777580_exc_T70
Condition
hepatic failure
NCT02777580_exc_T71
Condition
cirrhosis
NCT02777580_exc_T72
Condition
portal hypertension
NCT02777580_exc_T73
Condition
active hepatitis
NCT02777580_exc_T74
Condition
oesophageal varices
NCT02777580_exc_T75
Scope
hepatic failure, cirrhosis, portal hypertension (oesophageal varices) and active hepatitis
NCT02777580_exc_T76
Condition
Dementia
NCT02777580_exc_T77
Condition
renal insufficiency
NCT02777580_exc_T78
Qualifier
severe
NCT02777580_exc_T80
Condition
allergic reactions
NCT02777580_exc_T81
Drug
tenecteplase
NCT02777580_exc_T82
Drug
clopidogrel
NCT02777580_exc_T83
Drug
enoxaparin
NCT02777580_exc_T84
Drug
aspirin
NCT02777580_exc_T85
Scope
tenecteplase, clopidogrel, enoxaparin and aspirin