BACKGROUND This study is aimed to investigate the effect of local intracoronary bolus administration of combination eptifibatide and streptokinase to dissolve occlusive thrombus (TIMI grade 0/1) in patients with acute and subacute STEMI. METHODS This is a nonrandomized controlled study and approved by Health Research Ethical Committee, Medical Faculty of Universitas Sumatera Utara/Adam Malik General Hospital. Patients with acute and subacute STEMI after having been recanalized by the use of a small diameter (1.25 - 2.0 mm) balloon dilation or thrombectomy with manual thrombus aspiration device-TAD, successive administration of local intracoronary slow bolus 3.75 mg eptifibatide diluted with 5 ml saline via TAD in IRA vessel for 3 minutes, subsequent flushing of TAD with 2 ml saline, after 3 minutes followed by 100 kU streptokinase diluted with 5 ml saline for 3 minutes. Three minutes later performed angiography then inserted long stent (2 - 4 mm more than length size stenosis), finally stent deployment on culprit lesion in IRA vessel and occasionally continued with local intracoronary bolus nitroglycerine-NTG. Assessment of postprocedural TIMI and myocardial blush grade-MBG is graded by two independent intervention cardiologists who were blind to all data apart from coronary angiogram. Angioplasty procedure for case of patients was performed by single operator. RESULTS We enrolled 72 consecutive case patients at the study between March 1, 2015 and February 16, 2016, there were 66 males and 6 females, aged between 31 - 78 years, 41 anterior and 31 inferior wall infarct fulfilled the inclusion criteria. Mean symptom to procedural time was 121.4 hours (4.5 -384). All patients received local intracoronary slow bolus eptifibatide 3.75 mg and continuing with streptokinase 50 kU (6 patients), 100 kU (66 patients). Occasionally local intracoronary bolus NTG were given with doses was 100 mg (7 patients), 200 mg (15 patients) and 300 mg (18 patients). Diagnostic coronary angiogram showed56patients had TIMI 0 and MBG 0, 16 patients had TIMI 1 and MBG 1. Recanalized was done with balloon 65 patients and TAD 7 patients. After PCI, coronary angiogram showed 64 patients (88.9%) had TIMI 3, 8 patients (11.1%) TIMI 2, use of MBG criteria found 63 patients (87.5%) had MBG 3 and 9 patients (12.5%) MBG 2, and from echocardiographic assessment, we found elevation of LVEF (Teich) 7.83 - 19.81%. A control group of 45 colleagues' patients 38 males and 7 females, aged between 42- 75years,30anterior and15inferior wall infarct, symptom to procedural time 2 - 312 hours was treated with standard therapy. Diagnostic coronary angiogram showed 39 patients had TIMI 0 and MBG 0, 6 patients had TIMI 1 and MBG 1. After PCI, coronary angiogram showed 26 patients (57.8%) had TIMI 3 and MBG 3, 17 patients (37.8%) had TIMI 2and MBG 2, and2 patients (4.4%) had TIMI1 and MBG 1. We foundsignificant difference (PearsonChi Squarep<0.05, Fischer exact test CI 95% (0.067-0.439) of reperfusion results after PCI between two groups (case and control). There were no hypotensive effect of intra-coronary bolus NTG, allergic reaction, minor and major bleeding. CONCLUSION The use of local intracoronary bolus adjuvant therapy Zulfikri's cocktail (eptifibatide, streptokinase and nitroglycerine) showed a successful dissolve of occlusive thrombus, restored vessel lumen diameter and improved LV function in patients with acute and subacute STEMI.
Mukhtar, Z. (2016). TCTAP A-032 Local Intracoronary Bolus Administration of Combination Eptifibatide and Streptokinase in Primary Angioplasty. Journal of the American College of Cardiology, 67(16), S14. https://doi.org/10.1016/j.jacc.2016.03.044