Case report of repeat thrombolytic therapy in patient with acute circular-apical myocardial infarction, complicated anginous status

Presented clinical case report illustrates nonstandart approach use repeat thrombolytic therapy patient 49 y.o. with acute circular – apical myocardial infarction, after noneffective primary systemic thrombolytic therapy rtPA. Moreover, repeat thrombolytic therapy in hospital stage was vital alternative in case with significant tamely delay mechanical reperfusion. After 90 minutes then introduction rtPA has been done, we got negative dynamic on ECG in the form of additional ST-segment elevation at other (early intact) lead, and reccurent anginous pain refractory to standard doses narcotic analgesic. In connection with remote PCI – center, we supposed significant tamely deIlay to mechanical reperfusion. In view of this factors, high risk to undesired event, refractory anginous pain, we made decision of repeat thrombolytic therapy with non-immunogenic staphilokinase, and it has been effective. At a later time the disease is taking it’s normal course.

1. Данные Росстата на 22.06.2019. URL: https://www.gsk.ru

2. Erlikh et al. The First Moscow Acute Coronary Syndrome registry: patient characteristics, treatment and exodus during in hospital stage. Journal Kardiologiia. 2013;12:4-14].

3. Banerjee P, Clark AL, Norell MS. Repeat thrombolysis for acute myocardial infarction. Int J Cardiol. 2005 Jul 20;102(3):515-9. https://doi.org/10.1016/j.ijcard.2004.05.067

4. Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, Claeys MJ, Dan GA, Dweck MR, Galbraith M, Gilard M, Hinterbuchner L, Jankowska EA, Jüni P, Kimura T, Kunadian V, Leosdottir M, Lorusso R, Pedretti RFE, Rigopoulos AG, Rubini Gimenez M, Thiele H, Vranckx P, Wassmann S, Wenger NK, Ibanez B; ESC Scientific Document Group. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. 2023 Oct 12;44(38):3720-3826. https://doi.org/10.1093/eurheartj/ehad191

5. Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet. 2003 Jan 4;361(9351):13-20. https://doi.org/10.1016/s0140-6736(03)12113-7

6. Boersma E; Primary Coronary Angioplasty vs. Thrombolysis Group. Does time matter? A pooled analysis of randomized clinical trials comparing primary percutaneous coronary intervention and inhospital fibrinolysis in acute myocardial infarction patients. Eur Heart J. 2006 Apr;27(7):779-88. https://doi.org/10.1093/eurheartj/ehi810

7. Wijeysundera HC, Vijayaraghavan R, Nallamothu BK, Foody JM, Krumholz HM, Phillips CO, Kashani A, You JJ, Tu JV, Ko DT. Rescue angioplasty or repeat fibrinolysis after failed fibrinolytic therapy for STsegment myocardial infarction: a meta-analysis of randomized trials. J Am Coll Cardiol. 2007 Jan 30;49(4):422-30. https://doi.org/10.1016/j.jacc.2006.09.033

8. Gershlick AH, Stephens-Lloyd A, Hughes S, Abrams KR, Stevens SE, Uren NG, de Belder A, Davis J, Pitt M, Banning A, Baumbach A, Shiu MF, Schofield P, Dawkins KD, Henderson RA, Oldroyd KG, Wilcox R; REACT Trial Investigators. Rescue angioplasty after failed thrombolytic therapy for acute myocardial infarction. N Engl J Med. 2005 Dec 29;353(26):2758-68. https://doi.org/10.1056/nejmoa050849

9. Christenson RH, Ohman EM, Topol EJ, Peck S, Newby LK, Duh SH, Kereiakes DJ, Worley SJ, Alosozana GL, Wall TC, Califf RM. Assessment of coronary reperfusion after thrombolysis with a model combining myoglobin, creatine kinase-MB, and clinical variables. TAMI-7 Study Group. Thrombolysis and Angioplasty in Myocardial Infarction-7. Circulation. 1997 Sep 16;96(6):1776-82. https://doi.org/10.1161/01.cir.96.6.1776

10. Mohannad EA. The effect of pain and Morphine use on complication rates after acute myocardial infarction. Health Science Journal 2016, Vol. 10, №5:1

11. Anas Abu Taha et al. Morphine Use Did Not Eliminate the Effect of Pain on Complications After Acute Myocardial Infarction. The Open Nursing Journal 2022;16. https://doi.org/10.2174/18744346-v16-e2206202

12. Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, Claeys MJ, Dan GA, Dweck MR, Galbraith M, Gilard M, Hinterbuchner L, Jankowska EA, Jüni P, Kimura T, Kunadian V, Leosdottir M, Lorusso R, Pedretti RFE, Rigopoulos AG, Rubini Gimenez M, Thiele H, Vranckx P, Wassmann S, Wenger NK, Ibanez B; ESC Scientific Document Group. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. 2023 Oct 12;44(38):3720-3826. https://doi.org/10.1093/eurheartj/ehad191