Does Adjunctive Prophylactic Intracoronary Infusion of Low Dose Alteplase PreventNo-Reflow Phenomenon During Primary Percutaneous Coronary Intervention?

Introduction: primary percutaneous coronary intervention (ppci) is the gold standard approachto restore blood flow in st-segment elevation myocardial infarction (stemi); however, the no-reflowphenomenon as a potential complication of ppci can worsen the outcomes. it has been hypothesized thatadjunctive prophylactic intracoronary infusion of low-dose fibrinolytic might improve the ppci outcomes;however, this theory is a matter of debate. the current study aims to investigate the value of adjunctiveprophylactic intracoronary low-dose alteplase to prevent the no-reflow phenomenon in patients with stemi.method: this case-control study was conducted on 80 stemi patients who underwent ppci. thepatients were assigned into the case group who were intervened by 10 mg adjunctive intracoronary alteplaseimmediately at the end of the balloon angioplasty (n=40) and controls (n=40) who underwent conventionalppci only. the angioplasty-associated outcomes including final timi score, need for no-reflow treatment,st-segment resolution, post-ppci complications, and death were compared between the groups.results: alteplase use was accompanied by significantly improved final timi flow scores (p-value<0.001)and fewer requirements for no-reflow treatments (p-value<0.001); however, it did not improve the stsegmentresolution (p-value=0.491). the mortality rate and post-angioplasty complications did not differbetween the groups (p-value>0.05).conclusion: based on the findings of this study, adjunctive infusion of low-dose intracoronary alteplaseduring ppci could not efficiently prevent the no-reflow phenomenon. although the final timi flow and needfor post-stenting no-reflow treatment improved, st-segment resolution did not occur dramatically. giventhat, this approach requires further investigations and should be considered cautiously.