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Effects of streptokinase on reflow in rescue percutaneous coronary intervention
Masoud Sanatkar1, Hassan Shemirani, Hamid Sanei
1Fellowship Resident, Cardiac Rehabilitation Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Insights
Rescue percutaneous coronary intervention (PCI) is a viable alternative to primary PCI for ST-elevation myocardial infarction (STEMI) when immediate equipment is unavailable. This study found no significant difference in no-reflow phenomenon or 24-hour complications between PPCI and rescue PCI strategies.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Primary percutaneous coronary intervention (PPCI) is the gold standard for ST-elevation myocardial infarction (STEMI).
- Limited equipment availability necessitates alternative strategies like thrombolysis followed by rescue PCI.
- Evaluating rescue PCI outcomes is crucial for managing STEMI when PPCI is not immediately feasible.
Purpose of the Study:
- To compare the incidence of no-reflow phenomenon and 24-hour complications between PPCI and rescue PCI in STEMI patients.
- To assess the safety and efficacy of rescue PCI as a secondary treatment strategy.
Main Methods:
- A cross-sectional study involving 143 STEMI patients (March-September 2011).
- Patients underwent either PPCI (with eptifibatide) or rescue PCI (following streptokinase if symptoms persisted).
- Data on demographics, medical history, PCI details, and 24-hour complications were collected and analyzed using statistical tests.
Main Results:
- No significant difference in the rate of no-reflow phenomenon between PPCI (46.9%) and rescue PCI (53.1%) groups.
- Overall 24-hour mortality was 6.3%, with no statistically significant association with rescue PCI.
- Adjusted analyses confirmed no significant correlation between rescue PCI and adverse outcomes, including no-reflow, death, or other complications.
Conclusions:
- Rescue PCI demonstrates comparable short-term outcomes to PPCI regarding no-reflow and complications in STEMI.
- While thrombolysis (streptokinase) may be more effective for clot lysis than eptifibatide, the subsequent rescue PCI procedure itself does not increase adverse events.
- Rescue PCI is a safe and effective strategy when primary PCI is not immediately accessible for STEMI management.
Background:
Primary percutaneous coronary intervention (PPCI) is the preferred treatment method for ST elevation myocardial infarction (STEMI). However, the required equipments are not available in all hospitals. Thus, due to shortage of time, some patients receive thrombolysis therapy first. Patients with chest pain and/or persistent ST segment elevation will then undergo rescue percutaneous coronary intervention (PCI). The present study evaluated and compared the frequency of no-reflow phenomenon and 24-hour complications after PCI among patients who underwent PPCI or rescue PCI.
Methods:
This cross-sectional study assessed no-reflow phenomenon, 24-hour complications, and thrombolysis in myocardial infarction (TIMI) flow in patients admitted to Chamran Hospital (Isfahan, Iran) with a diagnosis of STEMI during March-September, 2011. Subjects underwent PPCI if they had received eptifibatide. Rescue PCI was performed if patients had chest pain and/or persistent ST segment elevation despite receiving streptokinase (SK). Demographic characteristics, history of diseases, medicine, angiography findings, PCI type, and complications during the first 24 hours following PCI were collected. Data was then analyzed by Student's t-test, chi-square test, and logistic regression analysis.
Results:
A total number of 143 individuals, including 67 PPCI cases (46.9%) and 76 cases of rescue PCI (53.1%), were evaluated. The mean age of the participants was 58.92 ± 11.16 years old. Females constituted 18.2% (n = 26) of the whole population. No-reflow phenomenon was observed in 51 subjects (37.1%). Although 9 patients (6.3%) died during the first 24 hours after PCI, neither the crude nor the model adjusted for age and gender revealed significant relations between rescue PCI and death or no-reflow phenomenon. Rescue PCI and no-reflow phenomenon were not significantly correlated even after adjustments for age, gender, history of diabetes, hypertension, hyperlipidemia, coronary artery disease, smoking, platelets number, myocardial infarction level, the extent of stenosis, and the involved artery.
Conclusion:
According to the present study, although SK is more effective than eptifibatide in resolution of thrombosis and clots, rescue PCI did not differ from PPCI in terms of the incidence of no-reflow phenomenon or short-term complications.
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