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Updated: Sep 20, 2026
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
[Facilitated revascularisation in myocardial infarction with ST-segment elevation]
Mihály Józan-Jilling1, Iván Horváth, Ernó Kis
1Tolna Megyei Onkormányzat Balassa János Kórháza, Szekszárd, Kardiológiai Osztály.
Insights
This study shows that a combined half dose of alteplase (tissue plasminogen activator) and eptifibatide is an effective and safe treatment for acute coronary syndromes. This approach offers a viable alternative for patients requiring urgent revascularization.
Area of Science:
- Cardiology
- Interventional Cardiology
- Emergency Medicine
Background:
- Acute coronary syndromes (ACS) with ST-segment elevation (STEMI) require prompt reperfusion therapy.
- Traditional treatment strategies involve timely percutaneous coronary intervention (PCI) or fibrinolysis.
- An optimal revascularization strategy is crucial for improving patient outcomes in STEMI.
Purpose of the Study:
- To evaluate the efficacy and safety of a combined half-dose alteplase and eptifibatide therapy followed by urgent coronarography and revascularization in STEMI patients.
- To assess the feasibility of this approach in a clinical setting with potential transport delays to a catheterization laboratory.
Main Methods:
- A prospective study involving 20 patients (16 men, 4 women; mean age 55.6 years) with STEMI.
- Administration of a combined half dose of alteplase (tissue plasminogen activator) and eptifibatide (glycoprotein IIb/IIIa receptor antagonist).
- Urgent coronarography and subsequent revascularization (PCI or coronary artery bypass grafting) were performed.
Main Results:
- Coronarography revealed TIMI flow: 0 in 4 patients, 2 in 3 patients, and 3 in 13 patients.
- Revascularization included PCI in 14 patients and coronary artery bypass grafting in 4 patients (2 emergency, 2 elective).
- Hemorrhagic complications (hematemesis) occurred in 2 patients without requiring transfusion; one patient died post-emergency bypass surgery.
Conclusions:
- The combined half-dose alteplase and eptifibatide therapy followed by urgent revascularization is an effective and safe alternative for STEMI patients, particularly when transport to a catheterization lab is prolonged.
- Developing optimal revascularization strategies is essential for all Hungarian catheterization centers treating STEMI patients.
- This therapeutic approach is recommended for patients under 75 years old with acute myocardial infarction, considering the specific logistical challenges of the participating center.
Aims:
The authors performed urgent coronarography and revascularisation after administering a combined half dose of alteplase (tissue plazminogen activator) and eptifibatide (glycoprotein II/bIIIa receptor blocking agent) to patients suffering from acute coronary syndromes with persistent ST-segment elevation.
Methods:
During the period between 01 April to 15 December, 2001. 20 patients (16 men and 4 women, mean age: 55.6 years) were treated. The localization of infarction on the basis of ST-segment elevation was: 9 cases inferior, 10 cases anterior and patient with left bundle branch block in 1 cases. The mean time between the infarct related angina and hospital admission was 158 (30-600) minutes. The combined medical therapy was initiated after 34 (15-150) minutes on the average admission, and 123 (71-210) minutes later the patients were in the catheter laboratory.
Results:
Coronarography showed TIMI-0 flow in 4 cases, TIMI-2 flow in 3 cases and TIMI-3 flow in 13 cases. Acute percutan coronary intervention was done in 14 cases, aorto-coronary bypass surgery was performed in 4 cases (2 of them were emergency operations, the other 2 were done electively). Besides postpunctional haematomas, hemorrhagic complications in the form of haematemesis were observed in 2 cases, but there was no need for transfusion. The mean CK-MB release (between 14 patients) was 230.4 (30-1176) U/l. One patient died after the emergency bypass surgery.
Conclusions:
On the basis of initial results the authors emphasize the importance of working out the optimal revascularisation strategy for acute coronary syndrome patients with ST-segment elevation in every Hungarian catheter centre. The authors find this method--in their case the catheter laboratory is 60 kms away, time of transport is approximately 70-90 minutes--an effective and safe alternative therapy in patients under the age of 75 years with acute myocardial infarction.
