OR3. Admission blood glucose and ischemic time are associated with successful fibrinolysis in combined assessment of ST-segment resolution, myocardial infarction flow grade, and myocardial perfusion grade

Abstract

Abstract Background and Aims Fibrinolytic therapy (FT) is the alternative recommendation in patients with ST-segment elevation myocardial infarction (STEMI) if primary percutaneous coronary intervention (PCI) could not be perfomed timely at initial presentation. Successful revascularization of occluded infarct-related coronary arteries depends on complex mechanisms of hemodynamic, clinical, biochemical, and mechanical parameters. This study aimed to find out predictors of complete reperfusion after FT based on Thrombolysis in Myocardial Infarction (TIMI) 3 flow, Myocardial Blush Grade (MBG) 3, and ST-segment resolution. Method and Results This retrospective study was held in Saiful Anwar, Malang Hospital during 2017-2021, including total of 142 patients. All patients received FT and coronary angiographic evaluation post-FT. Those were divided into 3 groups, which included R0,1 (0/1 highest measure of reperfusion), R2 (2 highest measures of reperfusion), and R3 (3 highest measures of reperfusion). Admission blood glucose (ABG) (OR 0.99 [95%CI -0.16;-0.001]; p = 0.025), ischemic time (OR 0.82 [95%CI -0.491;-0.137]; p = 0.001), and triglycerides (OR 0.98 [95%CI 0.23;-0.006]; p = 0.001) were negatively correlated to the complete restoration of reperfusion (R3). ABG<140 mg/dL (AUC 0.701 [95%CI 0.612-0.790]; p = 0.000) and ischemic time<5 hours (AUC 0.742 [95%CI 0.645-0.839]; p = 0.000) were significant predictors for R ≥ 2. Coronary characteristics were not related to measure of reperfusion (p = 0.25). Conclusion ABG<140 mg/dL and ischemic time<5 hours are important predictors of successful reperfusion post FT (R ≥ 2), along with triglycerides. Early assessment of patients who are likely to have low parameter reperfusion (R < 2) would help promptly preparing for primary PCI.