Streptokinase

Abstract

Treatment failure: case reportA 47-year-old man exhibited treatment failure with streptokinase for anterior ST-elevation acute myocardial infarction (STEMI). The man, who was a smoker, was admitted to a hospital in Bangladesh from a remote hospital after the failure of streptokinase therapy to reperfuse anterior STEMI. He was previously presented to a local hospital in Bangladesh with a severe retrosternal pain for duration of 6h. As a result, a diagnosis of anterior STEMI was made. Therefore, he received first-line reperfusion therapy with IV streptokinase 1.5 million units concomitantly with morphine. He additionally received aspirin, clopidogrel and atorvastatin. After 2.5h of streptokinase administration, he was admitted to the department of cardiology catheterisation laboratory due to ongoing severe chest pain without any signs of reperfusion. On admission, he had persistent ST-segment elevation in the anterior leads. Additionally, he had left ventricular anterior wall akinesia with normal muscle thickness and hypercontractility of the inferior segments. The coronary angiography revealed a proximal left anterior descending coronary artery occlusion. Thus, treatment failure with streptokinase was considered. Thereafter, he received heparin [unfractionated heparin] for peri-procedural anticoagulation. After vessel wiring, thrombus aspiration was performed. Due to the failure of streptokinase therapy, he underwent an implantation of novel thin-strut bioresorbable-polymer sirolimus-eluting stent. The control angiography then showed lack of residual stenosis and lack of distal embolism. The laboratory findings showed an optimal reconstruction of the lumen in absence of any dissection and in absence of any in-stent thrombotic or plaque material and showed fully preserved side-branch access. After 3 days, he was discharged home in a good clinical condition.Malik F-T-N, et al. Thin-strut bioresorbable-polymer sirolimus-eluting stent use for an optimal result of rescue coronary angioplasty in acute myocardial infarction failed