Thrombolytic therapy before percutaneous coronary intervention improves short-term cardiac function evaluated by cardiac magnetic resonance for ST-segment elevation myocardial infarction

Abstract

Background

The necessity of thrombolytic therapy before percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) patients remains controversial, requiring further evaluation of potential benefits.

Purpose

To explore the efficacy of half-dose recombinant staphylokinase (r-SAK) intravenous bolus before PCI in STEMI patients.

Material and Methods

Patients with STEMI were allocated to r-SAK or normal saline groups before PCI. Cardiac magnetic resonance (CMR) at 5 days after MI evaluated cardiac function, myocardial tissue characteristics, and strain. Segments were classified by late gadolinium enhancement (LGE) extent.

Results

A total of 64 STEMI patients were divided into the r-SAK group (n = 33) and NS group (n = 31). Patients in the r-SAK group had a significantly higher left ventricular ejection fraction and cardiac output index (P = 0.045 and 0.024). There was no significant difference between the two groups in mapping parameters, infarct size, area at risk, or the incidence of microvascular obstruction (MVO) and intramyocardial hemorrhage (IMH) (all P >0.05). Regardless of the extent of LGE in the segments, patients in the r-SAK group exhibited significantly better segmental longitudinal strain (all P <0.001). In addition, patients from the r-SAK group had a better segmental circumferential strain in LGE segments (P = 0.044).

Conclusion

For STEMI patients expected to undergo PCI within 120 min of presentation, a single bolus of half-dose r-SAK administrated before PCI improved short-term cardiac function without increasing incidence of MVO or IMH.