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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Effect of Intracoronary Streptokinase Administered Immediately After Primary Percutaneous Coronary Intervention on Long-Term Left Ventricular Infarct Size, Volumes, and Function

Murat Sezer, MD^_*,_*, Arif Çimen, MD^_*, Emre Aslanger, MD^_*, Ali Elitok, MD^_*, Berrin Umman, MD^_*, Zehra Bura, MD^_*, Ebru Yormaz, MD, Cüneyt Türkmen, MD, I.k Adalet, MD, Yilmaz Nianci, MD^_* and Sabahattin Umman, MD^_*,

^_* Department of Cardiology, Istanbul University, Istanbul Faculty of Medicine, Capa-Istanbul, Turkey
Department of Nuclear Medicine, Istanbul University, Istanbul Faculty of Medicine, Capa-Istanbul, Turkey

Manuscript received January 20, 2009; revised manuscript received April 20, 2009, accepted April 20, 2009.

^_* Reprint requests and correspondence: Dr. Murat Sezer, Istanbul Faculty of Medicine, Department of Cardiology, Istanbul University, Capa-Istanbul, Turkey (Email: sezerm{at}istanbul.edu.tr).

Objectives: The purpose of this study was to investigate the reflections of the improvement in microvascular perfusion provided by adjuvant intracoronary streptokinase (ICSK) on late-phase infarct size and left ventricular volumes and functions.

Background: It has been shown that ICSK given immediately after primary percutaneous coronary intervention (PCI) improves myocardial perfusion in the early days of ST-segment elevation acute myocardial infarction.

Methods: Ninety-five patients undergoing primary PCI were randomized to ICSK 250 kU (n = 51) or no additional therapy (n = 44). Two days later, coronary hemodynamic indexes were measured to evaluate tissue-level perfusion. After 6 months, angiography, echocardiography, and technetium-99m single-photon emission computed tomography (SPECT) were performed.

Results: At 2 days, all indexes of microvascular function were significantly better in the ICSK group than in the control group, including coronary flow reserve (2.5 vs. 1.7, p < 0.001) and index of microvascular resistance (20.2 vs. 34.2, p < 0.001). At 6 months, infarct size (22.7% vs. 32.9%; p = 0.003) and left ventricular end-systolic (41.1 ml vs. 60.9 ml; p = 0.009) and end-diastolic volumes (95.5 ml vs. 118.3 ml; p = 0.006) were significantly smaller, and the ejection fraction was significantly higher (57.2% vs. 51.8%; p = 0.018) in the ICSK group compared with the control group.

Conclusions: In this study, it has been demonstrated that low-dose ICSK given immediately after primary PCI significantly limits long-term infarct size and preserves left ventricular volumes and functions. (Effect of Complementary Intracoronary Streptokinase Administration Immediately After Primary Percutaneous Coronary Intervention on Microvascular Perfusion and Late Term Infarct Size in Patients With Acute Myocardial Infarction; NCT00302419)

Key Words: acute myocardial infarction • primary percutaneous coronary intervention • infarct size • coronary microcirculation • intracoronary streptokinase • reperfusion injury

Abbreviations and Acronyms   cTFC = corrected Thrombolysis In Myocardial Infarction frame count   ICSK = intracoronary streptokinase   IRA = infarct-related artery   LV = left ventricular   MBG = myocardial blush grade   PCI = percutaneous coronary intervention   STEMI = ST-segment elevation myocardial infarction   SPECT = single-photon emission computed tomography   TIMI = Thrombolysis In Myocardial Infarction

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