Effects of streptokinase on reflow in rescue percutaneous coronary intervention

BACKGROUND: Primary percutaneous coronary intervention (PPCI) is the preferred treatment method for ST elevation myocardial infarction (STEMI). However, the required equipments are not available in all hospitals. Thus, due to shortage of time, some patients receive thrombolysis therapy first. Patients with chest pain and/or persistent ST segment elevation will then undergo rescue percutaneous coronary intervention (PCI). The present study evaluated and compared the frequency of no-reflow phenomenon and ۲۴-hour complications after PCI among patients who underwent PPCI or rescue PCI. METHODS: This cross-sectional study assessed no-reflow phenomenon, ۲۴-hour complications, and thrombolysis in myocardial infarction (TIMI) flow in patients admitted to Chamran Hospital (Isfahan, Iran) with a diagnosis of STEMI during March-September, ۲۰۱۱. Subjects underwent PPCI if they had received eptifibatide. Rescue PCI was performed if patients had chest pain and/or persistent ST segment elevation despite receiving streptokinase (SK). Demographic characteristics, history of diseases, medicine, angiography findings, PCI type, and complications during the first ۲۴ hours following PCI were collected. Data was then analyzed by Student’s t-test, chi-square test, and logistic regression analysis. RESULTS: A total number of ۱۴۳ individuals, including ۶۷ PPCI cases (۴۶.۹%) and ۷۶ cases of rescue PCI (۵۳.۱%), were evaluated. The mean age of the participants was ۵۸.۹۲ ± ۱۱.۱۶ years old. Females constituted ۱۸.۲% (n = ۲۶) of the whole population. No-reflow phenomenon was observed in ۵۱ subjects (۳۷.۱%). Although ۹ patients (۶.۳%) died during the first ۲۴ hours after PCI, neither the crude nor the model adjusted for age and gender revealed significant relations between rescue PCI and death or no-reflow phenomenon. Rescue PCI and no-reflow phenomenon were not significantly correlated even after adjustments for age, gender, history of diabetes, hypertension, hyperlipidemia, coronary artery disease, smoking, platelets number, myocardial infarction level, the extent of stenosis, and the involved artery. CONCLUSION: According to the present study, although SK is more effective than eptifibatide in resolution of thrombosis and clots, rescue PCI did not differ from PPCI in terms of the incidence of no-reflow phenomenon or short-term complications.   Keywords: Primary Percutaneous Coronary Intervention, Rescue Percutaneous Coronary Intervention, No-Reflow Phenomenon