Author + information
- Zulfikri Mukhtar1,
- Sutomo Kasiman1,
- Amran Lubis1,
- Nizam Zikri Akbar2,
- Andika Sitepu1,
- Cut Aryfa Andra1,
- Teuku Bob Haykal1,
- Miharza Aminunsyah3,
- Depri Sumantha4,
- Tengku Winda A5,
- Novia -1,
- Tawanita Brahmana6 and
- Hilfan Ade Putra Lubis1
- 1Adam Malik General Hospital / Faculty of Medicine Universitas Sumatera Utara, Medan, Indonesia
- 2Murni Teguh Memorial Hospital / Faculty of Medicine Universitas Sumatera Utara, Medan, Indonesia
- 3Langsa Hospital, Aceh, Indonesia
- 4Djasamen Saragih Hospital, Siantar, Indonesia
- 5Rantau Prapat Hospital, Medan, Indonesia
- 6Murni Teguh Memorial Hospital Medan, Indonesia
This study is to obtain the effects of local intracoronary single bolus administration of eptifibatide, streptokinase, and nitroglycerine in order to get complete reperfusion of epicardial artery and microcirculation level in patients with TIMI 0/1 acute and subacute STEMI.
This is an ongoing prospective nonrandomized controlled study and approved by Health Research Ethical Committee, Medical Faculty of Universitas Sumatera Utara. In the case group after recanalizing by thrombus aspiration device-TAD or balloon inflation then administered local intracoronary bolus 3.75 mg eptifibatide followed by 100 kU streptokinase and after stent deployment given 300 μg nitroglycerine. Assessment of postprocedural TIMI and MBG is graded by two independent interpreter cardiologists who were blind to all data apart from coronary angiogram.
We enrolled 120 patients (case) fulfilled inclusion criteria, between December 2015 and February 2017 (15months). There were 108 males and 12 females, aged between 39 – 78 years. 74 patients were anterior and 46 inferior wall infarct. Symptom to procedural time was 4.0 –384 hours. Preprocedural 81 patients had TIMI and MBG 0, 39 patients had TIMI and MBG 1. Recanalization was done with balloon in 100 and TAD 20 patients. Postprocedural 107 patients (89.2%) had TIMI and MBG 3, 13 patients (10.8%) had TIMI and MBG 2. Echocardiogram showed elevation of LVEF 7.73 – 27.06%. There were no significant hypotensive effect of intracoronary bolus 300 μg NTG, allergic reaction, minor and major bleeding, hospital mortality 2 of 120 (1.7 %) and 2patients readmission within 30 days follow-up. We compared this result with control 77 colleagues' patients, aged 35 – 80 years, treated with standard therapy. 45 patients with anterior and 32 inferior infarcts. Symptom to procedural time was 2.0 – 325 hours. Preprocedural 66 patients had TIMI and MBG 0, 11 patients had TIMI and MBG 1. Postprocedural42 patients (54.5%) were TIMI and MBG 3, 32 patients (41.6%) were TIMI and MBG2, 3 patients (3.9%) were TIMI and MBG 1. We found significant difference of reperfusion p <0.05, CI 95% (0.070 - 0.302) between two groups.
The use of local intracoronary single-bolus of eptifibatide, streptokinase and nitroglycerine showed a successful dissolve of an occlusive thrombus, reperfusion epicardial artery, and microcirculation level and improved LV function in patients with acute and subacute STEMI patients and showed better result compared with standard therapy.