Impact of Low-Dose Intracoronary Alteplase Infusion after Successful Primary Percutaneous Coronary Intervention

Abstract

Background and aim: In ST elevation myocardial infarction (STEMI), intracoronary thrombolysis after primary percutaneous coronary intervention (PPCI) was found to improve microvascular perfusion, yet without improvement in left ventricular (LV) remodeling. Our study aimed to find out possible effect on LV longitudinal function. Methods and results: 102 anterior STEMI patients eligible for PPCI were divided into: Alteplase group (53 patients; received intracoronary 0.3 mg/kg alteplase after PPCI) and control group (49 patients; treated with PPCI only). LV longitudinal function was assessed using tissue Doppler imaging (to measure mean S' and maximum Q-S' time difference) and speckle tracking (to measure global longitudinal strain (GLS)) 48 hours and 6 months after PPCI. In alteplase group, epicardial (p value < 0.001 for corrected TIMI frame count) and myocardial perfusion (p value for myocardial blush grade 0.03) were significantly higher. GLS and LV synchrony were better in alteplase group both at 48 hours (p value 0.02 and < 0.001 respectively) and at 6 months (p value < 0.001 for each). No difference in bleeding rates was noted between groups. Conclusion: Adjunctive low-dose alteplase infusion after PPCI improves microvascular perfusion and LV longitudinal function without increasing bleeding risk. ReseARch ARtIcle Inclusion criteria-First anterior wall STEMI suitable for PPCI of the infarct related artery (IRA).

Pathophysiology and Treatment of the No-Reflow Phenomenon in ST-Segment Elevation Myocardial Infarction: Focus on Low-Dose Fibrinolysis during Primary Percutaneous Intervention

“…In this analysis with a total of 1876 patients (Table 1 , Ref. [ 55 , 57 , 59 , 60 , 61 , 62 , 63 , 64 , 69 , 70 , 71 , 72 , 73 ]), i.c. fibrinolysis was linked to a reduction in major adverse cardiac events (odd ratio: 0.65, p = 0.003), and a greater left ventricular ejection fraction at 6-month follow-up (mean difference: 3.78, p = 0.0010).…”

“…By administering a pharmacologic agent at the site of arterial injury, a reservoir of the drug is created, potentially enhancing the dissolution of intraluminal clots [ 74 ]. In addition, lesion-directed delivery of drug may have a mechanical effect that might aid in breaking down the thrombus, thus increasing the surface area for fibrinolysis binding [ 69 ]. Overall, the advantages of local vs intracoronary administration might explain at least in part differences in the results between trials.…”