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Factors Associated With Normal Flow (TIMI 3) After Thrombolysis With Streptokinase in ST-Elevation Myocardial

Karthik Raghuram1, Surendran Deepanjali1, Ajith Ananthakrishna Pillai2

  • 1Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND.

Cureus
|February 22, 2021
PubMed

Insights

ST-segment recovery after streptokinase (STK) thrombolysis predicts successful reperfusion in ST-elevation myocardial infarction (STEMI) patients. Hematological markers like neutrophil-lymphocyte ratio (NLR) and mean platelet volume (MPV) did not predict reperfusion in this study.

Area of Science:

  • Cardiology
  • Internal Medicine
  • Emergency Medicine

Background:

  • Streptokinase (STK) thrombolysis is a primary reperfusion therapy for ST-elevation myocardial infarction (STEMI) in India.
  • Achieving Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 via coronary angiography (CAG) is crucial for better patient outcomes.
  • Previous research suggested hematological indices, including neutrophil-lymphocyte ratio (NLR) and mean platelet volume (MPV), might predict TIMI 3 flow.

Purpose of the Study:

  • To investigate clinical, electrocardiographic, and hematological parameters associated with TIMI 3 flow after STK thrombolysis in STEMI patients.
  • To evaluate the predictive value of NLR and MPV for achieving TIMI 3 flow post-thrombolysis.

Main Methods:

  • A prospective study of 201 adult STEMI patients presenting within 12 hours of chest pain onset.
  • Blood samples collected pre-thrombolysis for NLR and MPV estimation.
  • Coronary angiography (CAG) timing determined by cardiologists; one-month follow-up post-discharge.

Main Results:

  • TIMI 3 flow was achieved in 56% of patients.
  • ST-segment recovery of ≥50% at 90 minutes post-thrombolysis was significantly associated with TIMI 3 flow (adjusted OR 3.47).
  • NLR and MPV showed no significant association with TIMI 3 flow.

Conclusions:

  • ST-segment recovery ≥50% at 90 minutes is an independent predictor of TIMI 3 flow after STK thrombolysis in STEMI.
  • NLR and MPV are not reliable predictors of reperfusion success in this context.
  • Early electrocardiographic changes are more indicative of successful reperfusion than pre-treatment hematological markers.

Keywords:
infarct-related arteryst-elevation myocardial infarctiontimi 3 flow

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