Effects of intracoronary alteplase on microvascular function in acute myocardial infarction

Maznyczka, A. M. et al. (2020) Effects of intracoronary alteplase on microvascular function in acute myocardial infarction. Journal of the American Heart Association, 9(3), e014066. (doi: 10.1161/JAHA.119.014066) (PMID:31986989) (PMCID:PMC7033872)

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Background: Impaired microcirculatory reperfusion worsens prognosis following acute ST‐segment–elevation myocardial infarction. In the T‐TIME (A Trial of Low‐Dose Adjunctive Alteplase During Primary PCI) trial, microvascular obstruction on cardiovascular magnetic resonance imaging did not differ with adjunctive, low‐dose, intracoronary alteplase (10 or 20 mg) versus placebo during primary percutaneous coronary intervention. We evaluated the effects of intracoronary alteplase, during primary percutaneous coronary intervention, on the index of microcirculatory resistance, coronary flow reserve, and resistive reserve ratio. Methods and Results: A prespecified physiology substudy of the T‐TIME trial. From 2016 to 2017, patients with ST‐segment–elevation myocardial infarction ≤6 hours from symptom onset were randomized in a double‐blind study to receive alteplase 20 mg, alteplase 10 mg, or placebo infused into the culprit artery postreperfusion, but prestenting. Index of microcirculatory resistance, coronary flow reserve, and resistive reserve ratio were measured after percutaneous coronary intervention. Cardiovascular magnetic resonance was performed at 2 to 7 days and 3 months. Analyses in relation to ischemic time (<2, 2–4, and ≥4 hours) were prespecified. One hundred forty‐four patients (mean age, 59±11 years; 80% male) were prospectively enrolled, representing 33% of the overall population (n=440). Overall, index of microcirculatory resistance (median, 29.5; interquartile range, 17.0–55.0), coronary flow reserve(1.4 [1.1–2.0]), and resistive reserve ratio (1.7 [1.3–2.3]) at the end of percutaneous coronary intervention did not differ between treatment groups. Interactions were observed between ischemic time and alteplase for coronary flow reserve (P=0.013), resistive reserve ratio (P=0.026), and microvascular obstruction (P=0.022), but not index of microcirculatory resistance. Conclusions: In ST‐segment–elevation myocardial infarction with ischemic time ≤6 hours, there was overall no difference in microvascular function with alteplase versus placebo.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Macfarlane, Professor Peter and McConnachie, Professor Alex and Robertson, Dr Keith and Shaukat, Dr Aadil and Rocchiccioli, Dr John and Collison, Dr Damien and McEntegart, Dr Margaret and Welsh, Dr Paul and Gillespie, Dr Lynsey and McCartney, Dr Peter and Oldroyd, Dr Keith and Kennedy, Ms Julie and Hood, Dr Stuart and Berry, Professor Colin and Maznyczka, Dr Annette Marie and Eteiba, Dr Hany and Sattar, Professor Naveed
Authors: Maznyczka, A. M., McCartney, P. J., Oldroyd, K. G., Lindsay, M., McEntegart, M., Eteiba, H., Rocchiccioli, P., Good, R., Shaukat, A., Robertson, K., Kodoth, V., Greenwood, J. P., Cotton, J. M., Hood, S., Watkins, S., Macfarlane, P. W., Kennedy, J., Tait, C., Welsh, P., Sattar, N., Collison, D., Gillespie, L., McConnachie, A., and Berry, C.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
College of Medical Veterinary and Life Sciences > Institute of Infection Immunity and Inflammation
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Journal of the American Heart Association
ISSN (Online):2047-9980
Published Online:28 January 2020
Copyright Holders:Copyright © 2020 The Authors
First Published:First published in Journal of the American Heart Association9:e014066
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
174049T-TIME Coronary Physiology StudyColin BerryBritish Heart Foundation (BHF)FS/16/74/32573Institute of Cardiovascular & Medical Sciences
134217To identify the factors during the capture, post-capture handling and storage of Nephrops Norvegicus and its tailed products that affect...Douglas NeilYoungs Seafood Limited (YOUNGSEA)N/AInstitute of Biodiversity, Animal Health and Comparative Medicine