TY - JOUR T1 - Effect of coronary flow on intracoronary alteplase: a prespecified analysis from a randomised trial JF - Heart JO - Heart SP - 299 LP - 312 DO - 10.1136/heartjnl-2020-317828 VL - 107 IS - 4 AU - Annette Marie Maznyczka AU - Peter McCartney AU - Patrycja Duklas AU - Margaret McEntegart AU - Keith G Oldroyd AU - John P Greenwood AU - Douglas Muir AU - Saqib Chowdhary AU - Anthony H Gershlick AU - Clare Appleby AU - Hany Eteiba AU - James Cotton AU - Andrew Wragg AU - Nick Curzen AU - R Campbell Tait AU - Peter MacFarlane AU - Paul Welsh AU - Naveed Sattar AU - Mark C Petrie AU - Ian Ford AU - Keith A A Fox AU - Alex McConnachie AU - Colin Berry A2 - , Y1 - 2021/02/01 UR - http://heart.bmj.com/content/107/4/299.abstract N2 - Objectives Persistently impaired culprit artery flow (<TIMI 3) during primary percutaneous coronary intervention is a surrogate for failed myocardial perfusion. We evaluated the effects of intracoronary alteplase according to TIMI flow grade immediately preceding drug administration.Methods In T-TIME (trial of low-dose adjunctive alTeplase during primary PCI), patients ≤6 hours from onset of ST-elevation myocardial infarction (STEMI) were randomised to placebo, alteplase 10 mg or alteplase 20 mg, administered by infusion into the culprit artery, pre-stenting. In this prespecified, secondary analysis, coronary flow was assessed angiographically at the point immediately before drug administration. Microvascular obstruction, myocardial haemorrhage and infarct size were assessed by cardiovascular magnetic resonance (CMR) at 2–7 days and 3 months.Results TIMI flow was assessed after first treatment (balloon angioplasty/aspiration thrombectomy), immediately pre-drug administration, in 421 participants (mean age 61±10 years, 85% male) and was 3, 2 or 1 in 267, 134 and 19 participants respectively. In patients with TIMI flow ≤2 pre-drug, there was higher incidence of microvascular obstruction with alteplase (alteplase 20 mg (53.1%) and 10 mg (59.5%) combined versus placebo (34.1%); OR=2.47 (95% CI 1.16 to 5.22, p=0.018) interaction p=0.005) and higher incidence of myocardial haemorrhage (alteplase 20 mg (53.1%) and 10 mg (57.9%) combined vs placebo (27.5%); OR=3.26 (95% CI 1.44 to 7.36, p=0.004) interaction p=0.001). These effects were not observed in participants with TIMI 3 flow pre-drug. There were no interactions between TIMI flow pre-drug, alteplase and 3-month CMR findings.Conclusion In patients with impaired culprit artery flow (<TIMI 3) after initial balloon angioplasty/thrombus aspiration, intracoronary alteplase was associated with increased presence of microvascular obstruction and myocardial haemorrhage.Trial registration number NCT02257294. ER -