Abstract
Background: The presence of intracoronary heavy thrombus burden during primary percutaneous coronary intervention (PCI) plays increases the incidence of occurrence no-reflow phenomenon. Intracoronary thrombolytic therapy during primary PCI may improve microvascular perfusion. The aim of this study was to assess the effect of using 250,000 U of intracoronary streptokinase during primary PCI in patients presenting with an acute anterior wall ST segment elevation myocardial infarction (STEMI) with a definite thrombus in the left anterior descending coronary artery (LAD) on clinical and angiographic outcomes. Methods: Prospective cohort study conducted on 100 patients managed by primary PCI within 12 hours of symptom onset. Patients were divided into a study group (n=50) that received intracoronary streptokinase during primary PCI, and a control group (n=50) that received no additional therapy. Post-procedural TIMI flow grade, myocardial blush grade (MBG), and corrected TIMI frame count were assessed. Admission and peak CK-MB and percentage of ST segment resolution were recorded. At 6-months follow-up, assessment for major adverse cardiovascular events (MACE) was performed. Results: There were no differences between both groups regarding baseline clinical characteristics, time to reperfusion, and risk factors for the development of coronary artery disease. Peak CK-MB was significantly higher in the control group (p = 0.004). In the study group, a larger proportion of patients had TIMI 3 flow at the end of the procedure 42 (84%) vs 29 (58%) – p = 0.026, and a larger proportion had MBG 2 and 3, 23 (46%) vs 17 (34%) and 24 (48%) vs 14 (28%), respectively – p = 0.001. Corrected TIMI frame count at the end of the procedure was significantly smaller in the study group 24.2 ± 4.97 vs 31.28 ± 6.7 frames (p<0.0001). Conclusion: Administration of intracoronary streptokinase during primary PCI in patients presenting with acute anterior STEMI with definite coronary thrombosis improves coronary perfusion by improving TIMI flow grade, MBG, and shortening corrected TIMI frame count.
Highlights
Primary percutaneous coronary intervention (PCI) is the mainstay treatment strategy for patients presenting with acute ST-segment elevation myocardial infarction (STEMI)according to current practice guidelines [1, 2]
The aim of this study was to assess the effect of using 250,000 U of intracoronary streptokinase during primary PCI in patients presenting with an acute anterior wall ST segment elevation myocardial infarction (STEMI) who were found to have a definite thrombus in the left anterior descending coronary artery (LAD) on clinical and angiographic outcomes
This was a prospective cohort study conducted in the period from July 2017 to February 2019 on 100 patients presenting to the emergency department with an acute anterior wall STEMI for the first time managed by primary PCI within 12 hours of onset of angina or angina equivalent symptoms
Summary
Primary percutaneous coronary intervention (PCI) is the mainstay treatment strategy for patients presenting with acute ST-segment elevation myocardial infarction (STEMI)according to current practice guidelines [1, 2]. The use of intracoronary fibrinolytic therapy during primary PCI was studied based on the theory that the coronary microcirculation is occluded during no-reflow by microvascular fibrin, vessel wall components, circulating blood cells, and fibrinogen Such agents are thought to improve microvascular perfusion decreasing the size of the infarction and helping preserve left ventricular (LV) function especially in those presenting with a significant thrombus burden at the time of the myocardial infarction (MI) [6]. Conclusion: Administration of intracoronary streptokinase during primary PCI in patients presenting with acute anterior STEMI with definite coronary thrombosis improves coronary perfusion by improving TIMI flow grade, MBG, and shortening corrected TIMI frame count
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