This study aims to evaluate the potentiation effects of local intracoronary or intralesional single bolus administration of eptifibatide (EPT) and alteplase (ALP) to lysis the occlusive thrombus and distal micro-embolization in acute STEMI patients with TIMI 0/1.

This is a prospective nonrandomized controlled study. We included acute STEMI patients TIMI flow 0-1 and symptom onset 2-12 h. The culprit vessel was recanalized by TBE or balloon inflation, continued administration of EPT 3.75 mg, ALP 3 mg in 10 mL saline. After stent deployment NTG 200 µg was added. The control group is colleagues’ patients who performed pPCI without ALP. TIMI, MBG, and cTFC were graded by two interpreters.

There were 220 patients from October 2016 to July 2019, age 26-81 year, 201 males, 19 females, 119 anterior and 101 inferior wall infarctions. Preprocedural TIMI and MBG 0 were 182 patients, TIMI and MBG 1 were 38 patients. Postprocedural TIMI and MBG 3 were 197 patients, TIMI and MBG 2 were 23 patients, DTWCT 2 - 250 minutes (DTWCT <90 were 67 patients, DTWCT 91 to 120were 49 patients and DTWCT >121 minutes were104 patients), median-cTFC 16.3, LVEF increased7.44 - 31.5 %. There were 2 patients with gums bleeding, 1 hematuria, hospital mortality was 2.80 %, no mortality was found during 30 days follow-up.  The control group was 210 patients. Postprocedural TIMI and MBG 3 were 123 patients, TIMI and MBG 2 were 83patients, TIMI and MBG 1 were 4 patients. median-cTFC 20.0. Statistically, there was significant difference in postprocedural TIMI, MBG flow, cTFC between the 2 groups (p=0.001).

Local intracoronary or intralesional eptifibatide, alteplase, and nitroglycerine showed a better result in reperfusion of myocardial blood flow and improved LV function.