Effect of Local Delivery of Streptokinase Before Primary Percutaneous Coronary Intervention on Microvascular Perfusion in Patients with Acute Myocardial Infarction

Abstract

SUMMARY T his study is a prospective observational study on patients who presented to Ain Shams University hospital with acute STEMI managed by primary PCI in the period of time between 12/2013 and 1/2016. Patients who were diagnosed to have STEMI were subjected to thorough history taking, physical examination, 12 lead ECG, then they underwent primary PCI, labs were withdrawn and echocardiography was done. Study Evaluation points:  Angiographic and procedural data, with emphasis on the following: o Pre-procedural TIMI flow and MBG, local delivery of streptokinase versus thrombus aspiration device employment, mean length and diameter, Post-procedural TIMI flow, MBG and Mortality. In this study we found that the mean age was 52.6 years, ranging from 33 to 87 years. Most of our study population was males representing 84% of study population. The most prevalent risk factor was smoking (78%), HTN was the next (40%), and the third most common risk factor was DM (36%). Average Chest pain duration was 315 min while it was 39.30 min for the Door to balloon time. In our study, 25 patients underwent local delivery of streptokinase by clearway balloon before PCI while 25 patients underwent PCI with Thrombus aspiration device. In our study 92% of patients who underwent local delivery of Streptokinase by Clearway balloon achieved TIMI 3 flow grade and MBG 3, while only 68% of study population who underwent PCI with thrombus aspiration achieved TIMI 3 flow and MBG 3. Regarding TIMI flow and MBG after revascularization, 40 patients achieved TIMI 3 flow and MBG 3 (80%), 10 patients had less than TIMI 3 flow and MBG 3 (20%). In addition, since our protocol specified the administration of streptokinase locally at the thrombus, the drug would be expected to arrive at the target site much more quickly than with intracoronary and intravenous used. The results of our randomized trial show that the use of The Clearway RX drug delivery balloon for local delivery of streptokinase intracoronary was associated with better reperfusion at the microvascular level, Post-procedural TIMI 3 flow and MBG 3 achieved in 92% of patient. While, with intravenous administration of streptokinase reperfusion in 50% of patients with acute myocardial infarction can be expected, and with intracoronary administration of streptokinase reperfusion can be expected in 70% of patients.