Effect of Low-Dose Intracoronary Alteplase During Primary Percutaneous Coronary Intervention on Microvascular Obstruction in Patients With Acute Myocardial Infarction

Abstract

IMPORTANCE Microvascular obstruction commonly affects patients with acute ST-segment elevation myocardial infarction (STEMI) and is associated with adverse outcomes. OBJECTIVE To determine whether a therapeutic strategy involving low-dose intracoronary fibrinolytic therapy with alteplase infused early after coronary reperfusion will reduce microvascular obstruction.

Recombinant Tissue Plasminogen Activator (r-tPA) Induces In-Vitro Human Neutrophil Migration via Low Density Lipoprotein Receptor-Related Protein 1 (LRP-1)

“…Of interest, when percutaneous coronary intervention (PCI) is not an immediate option, current guidelines on ST-elevated myocardial infarction (STEMI) recommends fibrinolytic therapy with r-tPA [ 25 ]. Yet, a recent trial investigating the use of low-dose r-tPA as an adjunctive therapy to PCI was stopped because of futility [ 26 ], with a post-hoc analysis demonstrating that r-tPA could potentially increase microvascular obstruction in STEMI patients with ischemic time between 4 to 6 h [ 27 ]. As neutrophils play an important role in the pathophysiology of such a complication, we can speculate that r-tPA-mediated neutrophil degranulation and migration might have contributed to the neutral findings of the trial.…”

One-Year Outcomes After Low-Dose Intracoronary Alteplase During Primary Percutaneous Coronary Intervention

“…We found that MVO did not differ with alteplase vs. placebo. 2 Here, we report the efficacy and safety of intracoronary alteplase at 1year.…”

“…1 Distal embolization and microvascular thrombosis contribute to MVO. In the T-TIME trial (NCT02257294), 2 we hypothesized that low-dose intracoronary fibrinolysis with alteplase, in patients with adequate anticoagulation undergoing primary PCI, would reduce MVO extent as assessed by contrast enhanced cardiovascular magnetic resonance imaging. We found that MVO did not differ with alteplase vs. placebo.…”

The year in cardiology: acute coronary syndromes

“…(35) context, full dose intracoronary tenectaplase was inferior to abciximab in a small randomised trial (43) and using low dose intracoronary tenecteplase after reperfusion in the T-time trial also failed to reduce MVO measured using cardiac magnetic resonance imaging (CMRI). (44) Hypothesis generating results were presented by the Microvascular Reperfusion Utilising Sonothrombolysis in Acute Myocardial Infarction (MRUSMI) investigators. (45) Remote preconditioning in STEMI was studied in the CONDI-2/ ERIC PPCI trial, (46) survival remained only significant for high-risk NSTEMI.…”