ISSN: 2578-4633
Authors: Emara H*
Background: Intracoronary fibrinolytic administration immediately after primary PCI improves microvascular perfusion, decreases long-term infarct size, and improves LV function especially in patients with superimposed thrombus. As a consequence intracoronary thrombolytic is considered one of the pharmacological strategies for management of high thrombus burden lesions during PCI. Objectives: To assess the effect of low dose intracoronary streptokinase (ICSK) during primary PCI in patients presenting with acute anterior wall S-T segment elevation myocardial infarction with a definite thrombus in the left anterior descending artery on clinical, angiographic and echocardiographic outcomes. Methods: A total of 167 patients at the National Heart Institute, Egypt who had undergone primary PCI following an acute anterior wall STEMI presentation were included in this randomised controlled study (with a thrombus grading > thrombus grade 2) and no history of coronary angioplasty or myocardial infarction of the LADs. Patients were randomized into two groups: a control group (n = 90) receiving no extra therapy, and a study group (n = 77) receiving ICSK during primary PCI. Following PCI, angiographic results and S-T segment resolution were evaluated. A follow-up of MACE and echocardiographic results was subsequently carried out at 6 and 12 months. Results: Post-PCI indices of perfusion, such as TIMI flow grade 3 (79% vs. 51%), MBG 3 (43% vs. 20%), and cTFC (18.20 ± 4.01 vs. 30.95 ± 3.75), were considerably better in the ICSK group than in the control group. The ICSK group’s SWMA index score was substantially lower than that of the control group on the 6- and 12-month follow-ups (1.01 ± 0.02 vs 1.28 ± 0.04, and 1.22 ± 0.11 vs 1.7 ± 0.06, respectively). Conclusion: The use of low dose ICSK during primary PCI in acute anterior STEMI patients with coronary thrombi enhanced coronary perfusion and LV function, presenting a favorable approach for managing high thrombus burden PCI.
Keywords: Intracoronary Streptokinase; Thrombus Burden; S-T Elevation Myocardial Infarction; Primary PCI; Microvascular Perfusion; Distal Embolisation
