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
Condition: Acute Myocardial Infarction
MeSH terms: Myocardial Infarction; Infarction
Study type: Interventional
Phase: Phase 4

Summary: 
      The investigators hypothesized that complementary intracoronary streptokinase administration
      to primary percutaneous intervention in patients with acute myocardial infarction may provide
      further improvement in myocardial perfusion by dissolving microvascular thrombus [in situ
      formed or embolized from proximal site (spontaneous or following PCI)] and fibrin.
    

Detailed description: 
      Mechanical reperfusion for acute myocardial infarction (AMI) targets optimal
      revascularization of the epicardial artery but also aims at improved myocardial salvage. The
      goal of reperfusion therapies has shifted to include reperfusion downstream at the level of
      capillary bed, and it might be more appropriate that the hypothesis now be termed "the time
      dependent open artery and open microvascular hypothesis." Failure to achieve myocardial
      reperfusion despite the presence of a patent coronary artery has been termed the "no-reflow"
      phenomenon and attributed to microvascular dysfunction. It has become apparent that clinical
      outcomes are not only associated with patency of the epicardial artery, but also with patency
      of the microcirculation. Persistent impairment of microcirculation is associated with poor
      clinical outcome. Complete reperfusion in AMI settings necessitates reopening of the all
      consecutive vascular compartments all the way through the coronary circulation. But,
      embolization following percutaneous coronary intervention (PCI) and in situ microthrombi
      generation at the microvascular level makes this goal difficult to achieve. For this reason,
      mechanical intervention to the epicardial coronary artery with or without using distal
      protection wouldn't be enough to achieve ideal reperfusion at the ultimate (microvascular)
      level. At this point, it has become more evident that we need to develop more competent and
      feasible reperfusion strategies which can help us to achieve reperfusion as complete as
      possible at all levels.

      Hypothesis:

      Complementary intracoronary streptokinase administration to primary PCI may provide further
      improvement in myocardial perfusion by dissolving microvascular thrombus [in situ formed or
      embolized from proximal site (spontaneous or following PCI)] and fibrin. Improvement in
      microvascular perfusion may translate into reduction in infarct size and improvement in left
      ventricular function at long term.
    

Intervention name(s): intracoronary infusion,; primary percutaneous coronary angioplasty
Intervention type(s): Drug; Procedure
Intervention description(s): streptokinase, 250,000 units
Other intervention name(s): Streptase
Intervention MeSH terms: Streptokinase
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Acute myocardial infarction; primary angioplasty; streptokinase; microvasculature