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

Haytham Fathalla Emara; Wael Mahmoud El Kilany; Tarek Mounir Zaki; Ahmed Mohamed El-Missiri

doi:doi:10.11648/j.ccr.20200401.13

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

Haytham Fathalla Emara, Wael Mahmoud El Kilany, Tarek Mounir Zaki, Ahmed Mohamed El-Missiri

Published in Cardiology and Cardiovascular Research (Volume 4, Issue 1)

Received: 2 February 2020 Accepted: 14 February 2020 Published: 24 February 2020

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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.

Published in	Cardiology and Cardiovascular Research (Volume 4, Issue 1)
DOI	10.11648/j.ccr.20200401.13
Page(s)	11-16
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

Intracoronary Streptokinase, Coronary Thrombus, Myocardial Infarction, Primary Percutaneous Coronary Intervention

References

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[2]	Levine GN, Bates ER, Blankenship JC et al. 2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention and the 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation. 2016 Mar 15; 133 (11): 1135-47.
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Haytham Fathalla Emara, Wael Mahmoud El Kilany, Tarek Mounir Zaki, Ahmed Mohamed El-Missiri. (2020). Administration of Intracoronary Streptokinase During Primary Percutaneous Coronary Intervention for Anterior Wall Myocardial Infarction with Definite Coronary Thrombosis. Cardiology and Cardiovascular Research, 4(1), 11-16. https://doi.org/10.11648/j.ccr.20200401.13

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ACS Style

Haytham Fathalla Emara; Wael Mahmoud El Kilany; Tarek Mounir Zaki; Ahmed Mohamed El-Missiri. Administration of Intracoronary Streptokinase During Primary Percutaneous Coronary Intervention for Anterior Wall Myocardial Infarction with Definite Coronary Thrombosis. Cardiol. Cardiovasc. Res. 2020, 4(1), 11-16. doi: 10.11648/j.ccr.20200401.13

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AMA Style

Haytham Fathalla Emara, Wael Mahmoud El Kilany, Tarek Mounir Zaki, Ahmed Mohamed El-Missiri. Administration of Intracoronary Streptokinase During Primary Percutaneous Coronary Intervention for Anterior Wall Myocardial Infarction with Definite Coronary Thrombosis. Cardiol Cardiovasc Res. 2020;4(1):11-16. doi: 10.11648/j.ccr.20200401.13

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@article{10.11648/j.ccr.20200401.13,
  author = {Haytham Fathalla Emara and Wael Mahmoud El Kilany and Tarek Mounir Zaki and Ahmed Mohamed El-Missiri},
  title = {Administration of Intracoronary Streptokinase During Primary Percutaneous Coronary Intervention for Anterior Wall Myocardial Infarction with Definite Coronary Thrombosis},
  journal = {Cardiology and Cardiovascular Research},
  volume = {4},
  number = {1},
  pages = {11-16},
  doi = {10.11648/j.ccr.20200401.13},
  url = {https://doi.org/10.11648/j.ccr.20200401.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20200401.13},
  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 (pConclusion: 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.},
 year = {2020}
}

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TY  - JOUR
T1  - Administration of Intracoronary Streptokinase During Primary Percutaneous Coronary Intervention for Anterior Wall Myocardial Infarction with Definite Coronary Thrombosis
AU  - Haytham Fathalla Emara
AU  - Wael Mahmoud El Kilany
AU  - Tarek Mounir Zaki
AU  - Ahmed Mohamed El-Missiri
Y1  - 2020/02/24
PY  - 2020
N1  - https://doi.org/10.11648/j.ccr.20200401.13
DO  - 10.11648/j.ccr.20200401.13
T2  - Cardiology and Cardiovascular Research
JF  - Cardiology and Cardiovascular Research
JO  - Cardiology and Cardiovascular Research
SP  - 11
EP  - 16
PB  - Science Publishing Group
SN  - 2578-8914
UR  - https://doi.org/10.11648/j.ccr.20200401.13
AB  - 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 (pConclusion: 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.
VL  - 4
IS  - 1
ER  -

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Author Information

Haytham Fathalla Emara

Cardiology Department, National Heart Institute, Cairo, Egypt
Wael Mahmoud El Kilany

Cardiology Department, Ain Shams University, Cairo, Egypt
Tarek Mounir Zaki

Cardiology Department, Ain Shams University, Cairo, Egypt
Ahmed Mohamed El-Missiri

Cardiology Department, Ain Shams University, Cairo, Egypt

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Haytham Fathalla Emara, Wael Mahmoud El Kilany, Tarek Mounir Zaki, Ahmed Mohamed El-Missiri. (2020). Administration of Intracoronary Streptokinase During Primary Percutaneous Coronary Intervention for Anterior Wall Myocardial Infarction with Definite Coronary Thrombosis. Cardiology and Cardiovascular Research, 4(1), 11-16. https://doi.org/10.11648/j.ccr.20200401.13

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ACS Style

Haytham Fathalla Emara; Wael Mahmoud El Kilany; Tarek Mounir Zaki; Ahmed Mohamed El-Missiri. Administration of Intracoronary Streptokinase During Primary Percutaneous Coronary Intervention for Anterior Wall Myocardial Infarction with Definite Coronary Thrombosis. Cardiol. Cardiovasc. Res. 2020, 4(1), 11-16. doi: 10.11648/j.ccr.20200401.13

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AMA Style

Haytham Fathalla Emara, Wael Mahmoud El Kilany, Tarek Mounir Zaki, Ahmed Mohamed El-Missiri. Administration of Intracoronary Streptokinase During Primary Percutaneous Coronary Intervention for Anterior Wall Myocardial Infarction with Definite Coronary Thrombosis. Cardiol Cardiovasc Res. 2020;4(1):11-16. doi: 10.11648/j.ccr.20200401.13

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@article{10.11648/j.ccr.20200401.13,
  author = {Haytham Fathalla Emara and Wael Mahmoud El Kilany and Tarek Mounir Zaki and Ahmed Mohamed El-Missiri},
  title = {Administration of Intracoronary Streptokinase During Primary Percutaneous Coronary Intervention for Anterior Wall Myocardial Infarction with Definite Coronary Thrombosis},
  journal = {Cardiology and Cardiovascular Research},
  volume = {4},
  number = {1},
  pages = {11-16},
  doi = {10.11648/j.ccr.20200401.13},
  url = {https://doi.org/10.11648/j.ccr.20200401.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20200401.13},
  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 (pConclusion: 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.},
 year = {2020}
}

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TY  - JOUR
T1  - Administration of Intracoronary Streptokinase During Primary Percutaneous Coronary Intervention for Anterior Wall Myocardial Infarction with Definite Coronary Thrombosis
AU  - Haytham Fathalla Emara
AU  - Wael Mahmoud El Kilany
AU  - Tarek Mounir Zaki
AU  - Ahmed Mohamed El-Missiri
Y1  - 2020/02/24
PY  - 2020
N1  - https://doi.org/10.11648/j.ccr.20200401.13
DO  - 10.11648/j.ccr.20200401.13
T2  - Cardiology and Cardiovascular Research
JF  - Cardiology and Cardiovascular Research
JO  - Cardiology and Cardiovascular Research
SP  - 11
EP  - 16
PB  - Science Publishing Group
SN  - 2578-8914
UR  - https://doi.org/10.11648/j.ccr.20200401.13
AB  - 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 (pConclusion: 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.
VL  - 4
IS  - 1
ER  -

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