Local Intracoronary Bolus Administration of Combination Eptifibatide and Streptokinase in Primary Angioplasty Zulfikri Mukhtar, Sutomo Kasiman, Amran Lubis, and Nizam Akbar Cardiology Department of Medical School Sumatera Utara University, Adam Malik General Hospital, Murni Teguh Memorial Hospital and Colombia Asia Hospital, Medan, Indonesia. Abstract. Objective : This study purpose is to investigate effect of local intracoronary bolus administration of combination eptifibatide and streptokinase to resolve occlusive thrombus (TIMI flow 0 / 1) and prevention microvascular obstruction (MVO) in patients with acute STEMI. Background : Local Intracoronary bolus administration of eptifibatide during PCI in patients with acute STEMI is association with improve microvascular perfusion. Intracoronary streptokinase via infuse through the guiding catheter proves significantly limits long term infarct size and preserves left ventricular ventricular volume and function. Methods : This was a cohort, control nonrandomised study. Collecting samples began from March – September 2015. 38 patients with acute STEMI received local intracoronary slowly bolus eptifibatide 3.75 mg diluted with 10 ml of saline and continuing with streptokinase 100 kU diluted with 5 ml of saline, after recanalizing by using of balloon dilatation with small diameter (1.5 – 2.0 ) mm or thrombus aspiration catheter in IRA vessel, via thrombus aspiration device for Left Coronary Artery (LAD or LCx) and Guiding Catheter for RCA. Three minutes later, perfomed angiography and finally implanted long stent (3 – 5 mm more than length size stenosis) with direct stenting of culprit lesion in IRA vessel. 27 patients with acute STEMI received standard therapy, as controlled from other colleague patients.The primary end point was assessment of postprocedural TIMI and MBG was graded by two independent Intervention Cardiologists who were blinded to all data apart from coronary angiogram. Angioplasty procedure was performed by single operator. Result : . Patients aged between 36 to 75 years, 36 males and 2 females. Symptom to procedure time was 15 – 384 hours. Infarct location was 23 anterior and 15 inferior wall. IRA of RCA and LAD was 10 and 6. Diagnostic angiography result showed TIMI 0 and MBG 0 were 34 patients. TIMI 1, and MBG 1 were 2 patients. After Primary Angioplasty, TIMI 3 was found in 36 patients (94.7 %). TIMI 2 in 2 patient (5.3 %). MBG 3 in 36 patients (94.7 %), MBG 2 in 2 patients (5.3 %). In standard therapy patients, diagnostic angiography result showed TIMI 0 and MBG 0 were 25 patients. TIMI 1, and MBG 1 were 2 patients. After Primary Angioplasty, TIMI 3 was found in 14 patients (51.9 %). TIMI 2 in 13 patients (48.1 %). MBG 3 in 14 patients (51.9 %), MBG 2 in 2 patients (48.1%). Statistical analysis ( Person Chi-Square) from two groups were significantly different, P = 0.001. There were no complications of allergic reaction, minor and major bleeding. Conclusion : The using of intracoronary combination bolus eptifibatide 3.75 mg and streptokinase 100 kU showed that succesfull lysis (old) occlusive thrombus in patients with symptom of acute STEMI. Key words. STEMI-ST Segment Elevation Myocardial Infarction. TIMI-Thrombolysis in Myocardial Infarction. MBG-Myocardial Blush Grade. MPCG-Myocardial Perfusion Contraction Grade.
Posted by: Zulfikri Mukhtar, Cardiologist, Cardiology Department of Medical School Sumatera Utara University, Indonesia (28-Sep-2015)