Administration Of Streptokinase Research Articles

Decrease of prothrombin level during thrombolysis in acute myocardium infarction.

Previously, the direct interactions of Bβ26-42 fibrin residues with prothrombin were demonstrated. It was also shown that forming prothrombin complexes with E- or DDE-fragments causes non-enzymatic prothrombin activation. The direct measuring of the prothrombin level in the blood plasma of patients with acute myocardial infarction (AMI) allowed us to find a situation where such an activation can occur in vivo. Blood coagulation parameters in the blood plasma of patients with AMI were measured at 2 hours, three days, and seven days after the thrombolysis by streptokinase accompanied with intravenous administration of anticoagulants: unfractionated high molecular weight heparin (HMWH) and low-molecular-weight heparin (LMWH). The prothrombin level in the blood plasma of patients with AMI was normal before thrombolytic therapy and substantially decreased after streptokinase administration. This effect was prominent in the case of concomitant anticoagulant therapy with LMWH and was not observed when HMWH was applied. It can be explained by the fact that LMWH preferentially inhibits factor Xa, while the HMWH is an effective inhibitor of both factor Xa and thrombin. This observation suggested that the prothrombin level decrease was caused by the thrombin-like activity and possible autolysis of prothrombin by thrombin. Also, thrombolytic therapy with streptokinase caused the accumulation of fibrin degradation products (FDPs), some of which were able to bind prothrombin. The dramatic decrease of prothrombin level in the blood plasma of patients with AMI during thrombolysis allowed us to conclude the non-enzymatic prothrombin activation with the following autolysis of prothrombin that contributes to the pathology.

Multiorgan recovery in a cadaver body using mild hypothermic ECMO treatment in a murine model

BackgroundTransplant candidates on the waiting list are increasingly challenged by the lack of organs. Most of the organs can only be kept viable within very limited timeframes (e.g., mere 4–6 h for heart and lungs exposed to refrigeration temperatures ex vivo). Donation after circulatory death (DCD) using extracorporeal membrane oxygenation (ECMO) can significantly enlarge the donor pool, organ yield per donor, and shelf life. Nevertheless, clinical attempts to recover organs for transplantation after uncontrolled DCD are extremely complex and hardly reproducible. Therefore, as a preliminary strategy to fulfill this task, experimental protocols using feasible animal models are highly warranted. The primary aim of the study was to develop a model of ECMO-based cadaver organ recovery in mice. Our model mimics uncontrolled organ donation after an “out-of-hospital” sudden unexpected death with subsequent “in-hospital” cadaver management post-mortem. The secondary aim was to assess blood gas parameters, cardiac activity as well as overall organ state. The study protocol included post-mortem heparin–streptokinase administration 10 min after confirmed death induced by cervical dislocation under full anesthesia. After cannulation, veno-arterial ECMO (V–A ECMO) was started 1 h after death and continued for 2 h under mild hypothermic conditions followed by organ harvest. Pressure- and flow-controlled oxygenated blood-based reperfusion of a cadaver body was accompanied by blood gas analysis (BGA), electrocardiography, and histological evaluation of ischemia–reperfusion injury. For the first time, we designed and implemented, a not yet reported, miniaturized murine hemodialysis circuit for the treatment of severe hyperkalemia and metabolic acidosis post-mortem.ResultsBGA parameters confirmed profound ischemia typical for cadavers and incompatible with normal physiology, including extremely low blood pH, profound negative base excess, and enormously high levels of lactate. Two hours after ECMO implantation, blood pH values of a cadaver body restored from < 6.5 to 7.3 ± 0.05, pCO2 was lowered from > 130 to 41.7 ± 10.5 mmHg, sO2, base excess, and HCO3 were all elevated from below detection thresholds to 99.5 ± 0.6%, − 4 ± 6.2 and 22.0 ± 6.0 mmol/L, respectively (Student T test, p < 0.05). A substantial decrease in hyperlactatemia (from > 20 to 10.5 ± 1.7 mmol/L) and hyperkalemia (from > 9 to 6.9 ± 1.0 mmol/L) was observed when hemodialysis was implemented. On balance, the first signs of regained heart activity appeared on average 10 min after ECMO initiation without cardioplegia or any inotropic and vasopressor support. This was followed by restoration of myocardial contractility with a heart rate of up to 200 beats per minute (bpm) as detected by an electrocardiogram (ECG). Histological examinations revealed no evidence of heart injury 3 h post-mortem, whereas shock-specific morphological changes relevant to acute death and consequent cardiac/circulatory arrest were observed in the lungs, liver, and kidney of both control and ECMO-treated cadaver mice.ConclusionsThus, our model represents a promising approach to facilitate studying perspectives of cadaveric multiorgan recovery for transplantation. Moreover, it opens new possibilities for cadaver organ treatment to extend and potentiate donation and, hence, contribute to solving the organ shortage dilemma.

The Effect of the Door to Needle Time of Streptokinase Administration on the Left Ventricular Function and Thrombolysis in Myocardial Infarction (TIMI) Flow Grade in Patients With Anterior Myocardial Infarction: A Single-Center, Prospective Follow-Up stud

Early administration of thrombolytic agents is the standard treatment and crucial for the outcome for patients presenting with acute myocardial infarction (MI). This study was conducted to evaluate the door to needle time of streptokinase administration and the left ventricular function in patients with anterior MI. This study was a prospective, single-center study on participants with anterior MI who were received streptokinase and non-streptokinase groups. After administration of streptokinase, QTc was measured in hyper-acute, acute, and recent phases of anterior MI in the case group and compared with acute and recent phases in the control group. The left ventricular function in 5 and 42 days after emergency department arrival was measured and compared in two groups. The data were analyzed by descriptive statistics method and variance analysis in the SPSS software, version 22. The level of significance was considered to be 0.05. Among 87 participants (45 streptokinases, 42 non-streptokinase), there was a significant relationship between the door to needle time in patients who received streptokinase in 1 hour (P=0.000), 3 hours (P=0.007), and 6 hours (P=0.016) after onset the chest pain and an ejection fraction of the patients in 5 days after hospitalization. Also, there was a significant relationship between ejection fraction in 5 days (P=0.000) and 42 days (P=0.000) of administration streptokinase and door to needle time. Reduction of the door to needle time after anterior MI has significant effects on QTc and incidence of threatening arrhythmia.

Post Thrombolytic St-Segment Resolution Outcome in Acute Myocardial Infarction Patients

OBJECTIVES: The main objective of this study was to assess post thrombolytic resolution of ST-segment and its outcome in patients with acute myocardial infarction. METHODOLOGY: This Prospective Comparative Study was carried out at the Cardiology Unit of Ayub Teaching Hospital, Abbottabad. All patients irrespective of gender and age with ST-Segment elevation myocardial infarction (STEMI), having no immediate access to angioplasty and thrombolysed with streptokinase, were included in this study. ECG was taken at the beginning and 90 minutes after the administration of streptokinase. Based on ST-segment resolution on ECG taken at 90 minutes these patients were classified into group A and B. Group A included patients with ST-segment resolution while group B showed no resolution of ST-segment after streptokinase administration. These patients were followed during their hospital stay for complications such as arrhythmias, cardiogenic shock, acquired ventricular septal defects (VSD) aneurysm and death. RESULTS: Among 115 patients, 94 were male and 21 female. Group A included 102 (89%) patients and group B included 13 (11%). In group A, only 1 (0.98 %) patient developed complications and in group B, 13 patients (100%) developed complications. Arrhythmias were the most common complication among MI patients in group A while cardiogenic shock was the commonest complication in group B. CONCLUSION: ST-segment resolution is a practical and applicable indicator of successful thrombolysis and has a significant correlation with clinical outcome in acute myocardial patients after thrombolysis with streptokinase.

The Effect of the Door to Needle Time of Streptokinase Administration on the QTc Interval and the Incidence of Life-Threatening Arrhythmia in Patients With Anterior Myocardial Infarction

Early administration of thrombolytic agents is standard for patients presenting with acute myocardial infarction (MI). Also, prolonged QT intervals indicate a higher risk for sudden death in patients with MI. This study was conducted to evaluate the door to needle time of streptokinase administration and the incidence of life-threatening arrhythmia in patients with anterior MI. This study was a prospective, single-center study on participants with anterior MI, who were divided into streptokinase and non-streptokinase groups. After administration of streptokinase, QTc was measured in hyper-acute, acute, and recent phases of anterior MI in the group and compared with acute and recent phases in the non-streptokinase group. The incidence of life-threatening arrhythmia was measured and compared in two groups. The data were analyzed by descriptive statistics method and variance analysis in the SPSS software, version 22. The level of significance was considered to be 0.05. Among 87 participants, there was a significant relationship between the door to needle time of 30 minutes and QTc interval in the hyperacute phase (P=0.005). Also, QTc in the streptokinase group was significantly lower than the non-streptokinase group in the acute phase (P=0.003 vs. P=0.205) and recent phase (P=0.007 vs. P=0.228). The incidence of fatal arrhythmias in the streptokinase group was lower than in the others. The relationship between the incidence of VT/VF and TIMI flow grade was insignificant (P=0.089). Reduction of the door to needle time after anterior MI has significant effects on QTc and incidence of threatening arrhythmia.

Use of thrombolytic agents to treat neonatal thrombosis in clinical practice.

Among children, neonates have the highest incidence of thrombosis. Thrombolytic agents are used for the management of life and/or organ-threatening thrombosis. Literature on the efficacy and safety of thrombolytic agents in neonates is limited. We reviewed the evidence on dosing, administration, monitoring and treatment duration of tissue plasminogen activator (tPA), streptokinase and urokinase (URK) in neonates (≤ 28days). A systematic literature search was conducted of current databases from inception until 31 March 2021. The initial search yielded 6881 articles and 18 were retained for review. tPA, streptokinase and URK was utilized in 12, seven and four studies on 115, 51 and 16 patients, respectively. The dose range for tPA, streptokinase and URK was 0.01 -0.6 mg/kg/h, 50-2000 and 1000-0 000 units/kg/h, respectively, and treatment duration ranged from 30 min to 30 days. This is the first study to objectively summarize the efficacy and safety of thrombolytic agents in neonates. Overall, thrombolysis was associated with 87.9% complete or partial thrombus resolution and 7.4% recurrence risk. The bleeding risk associated with thrombolytic agents was 23.1% on pooled analysis, which is higher than other anticoagulants. Larger prospective studies are required to determine effective dosing regimens of these therapeutic drugs and further clarify their efficacy and safety. Blood Coagul Fibrinolysis 33:000-000 Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

Comparative study of the effect of tranexamic acid and exogenous fibrin monomer on fibrin formation in the injury area during stimulation of fibrinolysis by streptokinase

Introduction. Earlier studies of low-dose fibrin monomer (FM) demonstrated that low-dose FM has unique hemostatic properties in vivo.Aim — to compare the morphological consequences of intravenous administration of tranexamic acid (TXA) and FM with the hemostatic and hemostasiological effects in hypofibrinogenemia caused by the use of streptokinase after controlled liver injury.Materials and methods. The morphological pattern of fibrin formation in the liver injury area after spontaneous arrest of bleeding in the animals treated with streptokinase or placebo was studied in 73 male rabbits of the Chinchilla breed, split into four groups. In three groups, the study was performed under the conditions of intravenous administration of placebo, TXA, or FM against the background of fibrinolysis activation by streptokinase. Platelet count in the blood, the concentration of fibrinogen, as well as the results of calibrated thrombography, were taken into account.Results. Sequential administration of streptokinase and TXA was accompanied by decreased fibrinogen concentration (by 29.6 %) and, at the same time, a reduction in blood loss (by 15.4 times) in comparison with animals where placebo was used instead of TXA. A decrease in blood loss was associated with increased thickness of thrombotic deposits at the edge of the wound, mainly consisting of red blood cells. These observations were combined with data on the acceleration of thrombin formation in venous blood plasma in a calibrated thrombography test (Peak thrombin 65.4 nmol/L to 109.6 nmol/L in the placebo group). Compared to the observations where placebo was administered instead of FM, however, the sequential use of streptokinase and FM also led to a decrease in blood loss (by 11.0 times) despite decreased fibrinogen concentration (by 23.3 %). A decrease in blood loss was also associated with platelet consumption in venous blood and with increased thickness of thrombotic deposits on the injury surface, where, in addition to red blood cells, the accumulation of fibrin masses was determined by the morphological pattern.Conclusion. The mechanisms of the systemic hemostatic effect of TXA and FM are different, despite the similarity of the achieved hemostatic effects in the conditions of stimulation of blood fibrinolytic activity. These findings expand the understanding of new therapeutic possibilities for reducing post-traumatic blood loss.

CATHETER-DIRECTED THROMBOLYSIS AS A METHOD OF CHOICE IN THE TREATMENT OF ACUTE THROMBOSIS OF DEEP VEINS OF THE LOWER EXTREMITIES

Summary. Introduction. Acute thrombosis of deep veins (DVT) of the lower extremities is a pathology that requires immediate treatment, but most thrombolytics do not work effectively, except for catheter-directed thrombolysis.&#x0D; Research aim. Rationalization of DVT treatment, determination of the catheter thrombolysis method as the most effective way to eliminate proximal thrombosis of deep veins.&#x0D; The analysis was based on the results of the treatment by different thrombolytic drugs the patients with the given pathology.&#x0D; Results and discussion. According to the analysis the most effective method of DVT treatment is catheter-guided administration of streptokinase, because streptokinase is the most effective anticoagulant, and its local action on the mass of the thrombus allows for complete elimination of the thrombus in a relatively short time without the counter allergic reaction to the infusion of streptokinase.&#x0D; Conclusions. Catheter-directed infusion of streptokinase as a method of treatment of acute thrombosis of the lower extremities has significantly better treatment results compared to other methods of treatment of this pathology.

St Segment Resolution in Patients given Streptokinase Injection along with Guideline directed Medical Therapy

Objective: To determine the ST resolution in patients given streptokinase along with guideline medical therapy Methodology: This descriptive cross sectional study was carried out in department of Cardiology DHQTH KDA Kohat on 109 patients after obtaining informed consent from the patients. Patients were given guideline directed medical therapy &amp; streptokinase for ST elevation MI. The ST-segment elevation resolution was calculated after 90 minutes of treatment with streptokinase, and stratified as complete ST segment resolution (&gt; 70% ST-resolution), partial resolution (30-70% ST-resolution), or failed resolution (&lt; 30% ST-resolution). Results: Out of 109 patients, 33 were females &amp; 76 were male patients. Mean age of the population was 57±11.64 (95% CI). Time from onset of chest pain to administration of thrombolytic &amp; guideline directed medical therapy was within 6 hours for 95 patients (87.5%).Out of 109, 9(8%) patients had minor gum bleeding. Conclusion: Administration of streptokinase is cost effective therapy for STEMI patients &amp; give good resolution of ST segment on ECG. Key Words: Myocardial infarction, ST resolution

Sonothrombolysis of embolic carotid artery, using pesda microbubbles- mediated B-mode ultrasound- guided extracorporeal pulsed low- level focused confocal dual frequency ultrasound accompanied by streptokinase administration

Background and Aims: Therapeutic ultrasound was found to selectively lyse thrombi with a wide margin of safety. Ultrasound effects sonothrombolysis by selective disruption of the fibrin matrix of the thrombus. In this study, we developed an experimental sonothrombolysis system, and investigated its effectiveness on carotid artery recanalization, accompanied by intravenous streptokinase and PESDA (perfluorocarbon exposed sonicated dextrose albumin) microbubbles administration, wherein diagnostic ultrasound imaging system is combined with the therapy system, with a goal of increased safety.

Effect of optison microbubbles- mediated B-mode ultrasound- guided focused low- level confocal dual pulse electrohydraulic shock wave- assisted streptokinase thrombolysis on embolic carotid artery

Background and Aims: In this study, we developed an experimental focused low- level confocal dual pulse electrohydraulic shock wave thrombolytic therapy system, and investigated its effectiveness on common carotid artery recanalization, accompanied by intravenous streptokinase and Optison microbubbles administration, wherein diagnostic ultrasound imaging system is combined with the therapy system, with a goal of increased safety.

Arterial Occlusion After Hyaluronic Acid Injection: Treatment With Hyaluronidase and Streptokinase.

The most feared complication of the hyaluronic acid injections in the periorbital region is embolism of the central retinal artery. The present study aimed to compare the effectiveness of hyaluronidase administered intravenously (systemically) alone or in combination with streptokinase with that of intra-arterial revascularization. Thirty rats were divided into 5 groups. The bilateral oblique groin flap of the rats was raised; the right side was the experiment group, and the left side was the sham control. The right superficial epigastric artery was occluded with a hyaluronic acid injection. After occlusion, no additional procedures were performed in group 1, whereas group 2 received systemic hyaluronidase, group 3 received intra-arterial hyaluronidase, group 4 received systemic hyaluronidase and streptokinase, and group 5 received intra-arterial hyaluronidase and streptokinase. On the seventh day, the rats were killed, flap necrosis rate was calculated, and histological examination was performed. There was no significant difference in the necrosis rates of the rats in groups 2, 3, 4, and 5 (P > 0.05). In histological evaluation, the histological view closest to normal arterial structure was observed in group 4. Immunohistochemical analysis revealed that the ischemia scores of systemic therapy were significantly lower than those of intra-arterial therapy. These results have shown that hyaluronidase and streptokinase administered systemically is as effective as intra-arterial revascularization and does not cause arterial wall degeneration. It has been shown that systemic administration of hyaluronidase and streptokinase is as successful as intra-arterial revascularization in the treatment of arterial embolism with hyaluronic acid.

Accuracy of Resolution of ST-Segment Elevation in Electrocardiogram to Determine the Patency of Infarct-Related Artery.

Introduction: There is very limited data comparing the accuracy of ECG to angiography in predicting reperfusion status. In this study, we will determine the accuracy of ECG change i.e. resolution of ST-segment elevation in predicting infarct-related artery (IRA) patency after thrombolysis in patients with ST-segment elevated myocardial infarction (STEMI), in comparison to angiography.Methods: Three hundred and forty-one (n = 341) patients with acute STEMI received streptokinase, a thrombolytic agent within 12 hours of symptoms, and were enrolled in the study via consecutive convenient non-probability sampling. ECG was recorded as soon as the patient arrived in the emergency unit of cardiology. Subsequent ECG was recorded three hours after the administration of streptokinase to look for resolution of ST-segment elevation. ST-segment resolution was classified as greater/equal to 50% resolved or less than 50% resolved. Coronary angiography was performed within 24 hours of hospitalization and flow in the IRA was assessed.Results: The most common site of myocardial infarction (MI) was the anterior wall (50.1%) and the commonest artery involved was the left anterior descending artery (44.2%). On ECG, ST-resolution of more than 50% was found in 242 (70.9%) participants. Thrombolysis in MI (TIMI) grade III flow in angiography was found in 211 (61.8%) participants. The sensitivity and specificity of ST-resolution to detect TIMI grade III flow was 94.79% and 67.69%, respectively, while accuracy was 84.46%.Conclusion: ST-resolution on ECG after streptokinase can predict IRA patency on coronary angiography with moderate to good accuracy. ECG can assist in predicting the impact of streptokinase early in the course of management and give an option of monitoring patient prognosis with a non-invasive test in patients not comfortable with angiography.

A Randomized Study Comparing Patency of Infarction Related Vessel at Time of Primary PCI in Patients Who Received Streptokinase and Who Did Not

Coronary blood flow in an infarct related artery (IRA) in patients that had streptokinase (SK), as the fibrinolytic of choice before percutaneous intervention (PCI), in comparison to the blood flow in patients that underwent primary percutaneous intervention (PPCI) has not been well understood or considered for studies in recent times. All patients presenting with STEMI diagnosis within less than 12 hours from diagnosis either at the centre or referred to the center after SK were screened. 200 patients were randomized into primary PCI (PPCI) or pharmacoinvasive PCI following SK (PhI-SK) administration 3-24 hours after SK. Failed SK patients underwent rescue PCI immediately. The outcome of IRA patency pre- and post PCI in both groups along with short term outcome of bleeding, re-infarction or cardiovascular death in 30 days were looked at. The end points were reached in 81 of 89 (91.0%) in the SK group and 21 of 98 (21.4%) in the PPCI group (p-value <0.001), while TIMI 3 flow was seen in 87 of 89 (98.7%) patients post PCI in the SK group and 69 of 98 (70.4%) patients of PPCI (p-value <0.001). The outcomes of bleeding, MI and death were not different among the groups. We concluded that Fibrinolysis with SK is a viable and safe reperfusion strategy in STEMI especially in low- and middle-income countries (LMICs), where PPCI is not commonly available within the guideline recommended time. It can reduce stress and risk of complications that can occur during PPCI. There is no any difference in the early outcomes of bleeding, MI and death between the two groups.

Is there a role for tissue plasminogen activator as a novel treatment for refractory COVID-19 associated acute respiratory distress syndrome?

Is there a role for tissue plasminogen activator as a novel treatment for refractory COVID-19 associated acute respiratory distress syndrome?

Posttraumatic bleeding reduction by systemic administration of fibrin monomer in thrombolytic therapy

Background. There is a continued search for effective and safe drugs with systemic hemostatic effects. Experimental data from previous studies show that low-dose fibrin monomer (FM) can reduce posttraumatic bleeding without causing activation of clotting in the circulating blood.Aim. To study the systemic hemostatic and hemostasiological effects of prophylactic intravenous administration of FM on the background of fibrinolysis activation by streptokinase.Methods. In a placebo-controlled study using male rabbits, fibrinolysis was activated by intravenous administration of streptokinase at a dose of 150,000 IU/kg. One hour before liver injury, FM was administered intravenously at a dose of 0.25 mg/kg. Tranexamic acid (TXA) was administered intravenously at a dose of 15 mg/kg 30 min before injury as a reference drug. After metered-dose injuring, blood loss was estimated as % of the circulating blood volume and by the rate of blood loss (mg/s). The study of blood platelet count, activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen concentration and the results of rotational blood thromboelastometry were taken into consideration.Results. Administration of FM and TXA before fibrinolysis activation by streptokinase reduced the blood loss volume by 11.0 and 15.4 times, respectively. FM and TXA both reduced the blood loss rate by 3.8 times compared to the placebo group that received the same fibrinolytic. The administration of streptokinase in all cases was accompanied by 23–30% a decrease in the fibrinogen concentration without affecting APTT and TT. The hemostatic effects of FM and TXA were observed in vivo while preserving the density properties of the blood clot (according to the parameters of α angle, MCF and A10 in thromboelastometry) despite the administration of streptokinase, whereas a significant decrease in these parameters was observed in the placebo group.Conclusion. The systemic hemostatic effects of FM at a dose of 0.25 mg/kg with fibrinolysis activation by streptokinase were close to the effects of TXA. Thus, FM administration can be considered a promising hemostatic therapy for the reduction of thrombolysis-associated bleeding. Received 18 December 2019. Accepted 22 January 2020. Funding: The study was supported by a grant from the Russian Foundation for Basic Research (No. 18-415-220001), Altai State Medical University. Conflict of interest: Authors declare no conflict of interest. Author contributionsConception and study design: A.P. Momot, V.M. Vdovin, I.I. ShakhmatovData collection: V.M. Vdovin, D.A. Orekhov, V.O. Krasyukova, N.A. Lycheva, D.A. Momot, V.E. Chernus, V.V. TerjaevData analysis: A.P. Momot, V.M. VdovinDrafting the article: V.M. Vdovin, A.P. MomotCritical revision of the article: A.P. Momot, В V.M. VdovinStatistical analysis: V.M. VdovinFinal approval of the version to be published: V.M. Vdovin, A.P. Momot, D.A. Orekhov, V.O. Krasyukova, I.I. Shakhmatov, N.A. Lycheva, D.A. Momot, V.E. Chernus, V.V. Terjaev

Body mass index and in-hospital outcomes in patient's ≥80 years with ST Elevation Myocardial Infarction. Results from low income country without coronary intervention

BackgroundIn most scenarios from low/middle income countries, pharmacological approach for ST elevation Myocardial Infarction is still use. In these setting and increase proportion of elderly patients is awaited. So it is also expected to have older patients with suboptimal treatment and risk stratification. ObjectiveTo investigate the impact of the body mass index (BMI) on in-hospital outcomes in a cohort of elderly (≥80 years) patients, from a center without coronary intervention. MethodsPatient's ≥80 years of age admitted to our institution between June 2014 and May 2019 with STEMI, were divided according BMI tertiles (BMI tertile 1: ≪22.36 kg/m2, BMI tertile2: 22.36–25.71 kg/m2, and BMI tertile 3: ≫25.71 kg/m2). The primary endpoint was all-cause in-hospital mortality ResultsOut of 118 patients, 41 (34.74%) were women. Median age was 84.4 ± 3.5 years and median BMI 24.1 ± 3.7 kg/m2. Women had a higher BMI than men (24.4 ± 4.0 vs 24.0 ± 3.6; p: 0.535). All-cause mortality was 33.3%, 2.5%, and 15% for lower, middle, and higher BMI tertiles (p=0.002). To belong to BMI tertile 1 was associated with an increased all-cause mortality (OR: 5.15, 95% CI 1.84–14.28, p = 0.001); and in patients without administration of streptokinase (OR: 9.52, 95% CI 2.34–38.45, p = 0.001). ConclusionThis study reports association between lower BMI values and increased mortality in elderly patients with and without pharmacological reperfusion with streptokinase.

Administration of Intracoronary Streptokinase During Primary Percutaneous Coronary Intervention for Anterior Wall Myocardial Infarction with Definite Coronary Thrombosis

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.

P955Assessment of coronary and myocardial reperfusion as well as left ventricular infarct size and function following streptokinase administration immediately after Primary coronary intervention

Abstract Background Reperfusion injury might be considered a consequence of insufficient myocardial perfusion (MP) due to microthrombi (MT) embolization into the microcirculation. Streptokinase (SK) a fibrinolytic agent, if injected into the culprit artery immediately after primary percutaneous coronary intervention (PPCI) might tackle and dissolve these MT resulting in better MP and function. Methods Sixty four patients presenting within 24 hours by their first ST elevation myocardial infarction, underwent PPCI, then equally divided into 2 groups; G1 received 250 kU of intracoronary SK (ICSK) vs saline in G2. Successful coronary perfusion was defined as corrected TIMI frame count (cTFC) &lt;28 frames, and successful MP as TIMI myocardial blush grade (TMBG) 3. Evaluation of left ventricular (LV) function was done by comparing the baseline LV global longitudinal strain (GLS) before and 1-month after PPCI. Assessment of infarct size was done by measuring peak CK-MB, CK-MB area under the curve and ST segment resolution (STR) 90 min after PPCI. Results Thirty minutes after ICSK, cTFC (fig) was significantly lower (P≤0.05), while TMBG (fig) was significantly higher (P≤0.02) in G1 vs G2. Peak CK-MB, CK-MB area under the curve were significantly lower (P≤0.015 &amp; P≤0.001 respectively) while STR≥70%was significantly higher in G1 (P≤0.045). Multivariate logistic regression analysis showed that the likelihood of achieving successful MP post-PPCI is associated with ICSK administration [OR=0.123, 95% CI (0.02–0.75), P≤0.024] and total ischemic time (ROC curve). Multivariate linear regression analysis showed that each of, immediate ICSK administration post-PPCI and TMBG were independent predictors for LV GLS improvement after one month. No significant difference in bleeding risk between G1&amp;2 (p=1). Conclusion ICSK given immediately after primary PCI was an independent predictor of successful coronary and myocardial reperfusion. It significantly led to reduction of infarct size and improvement of LV GLS.

B- Mode Ultrasound- Guided Catheter- Based Q-Switched Nd: Yag Laser- Mediated Inertial Cavitation Therapy Of Embolic Artery Accompanied By Simultaneously Streptokinase And Pesda Microbubbles Administration

B- Mode Ultrasound- Guided Catheter- Based Q-Switched Nd: Yag Laser- Mediated Inertial Cavitation Therapy Of Embolic Artery Accompanied By Simultaneously Streptokinase And Pesda Microbubbles Administration