Comparison of the effect of recombinant human pro-urokinase and tirofiban on myocardial blood flow perfusion in ST elevation myocardial infarction patients receiving primary percutaneous coronary intervention

Abstract

Ischemia/reperfusion (I/R) injury is associated with primary percutaneous coronary intervention (PPCI). The current study was performed to compare the effect of tirofiban and recombinant human pro-urokinase (rh-proUK) on the improvement of coronary slow blood after PPCI. Sixty-five ST elevation myocardial infarction (STEMI) patients treated with rh-proUK and an equal number treated with tirofiban after PPCI were employed in the current study. The clinicopathological information regarding the biochemical parameters, thrombolysis in myocardial infarction (TIMI) grade, hemodynamics parameters, thrombus core (TS), sum-STR, left ventricular ejection fraction (LVEF), blood routine parameters, high-sensitivity C-reactive protein (CRP) level, uric acid, hepatorenal function, electrocardiogram (ECG), and echocardiography before and after the interventions were collected. The differences in those parameters between the 2 groups then compared with assess the treatment effect and side effects associated with the both therapies. The results showed that the TIMI level post-intervention ( P = .03), the proportion of TIMI myocardial perfusion grade level III ( P = .04), the changes in thrombus score ( P < .001) in rh-proUK group were significantly higher than those in tirofiban group while the corrected TIMI Frame Count (CTFC) ( P = .02), the incidence of slow flow ( P = .02), the thrombus score post-intervention ( P < .001), the stent length ( P = .02), and the number of receiving administration of sodium nitroprusside ( P = .01) were significantly lower than those in tirofiban group. Moreover, the levels of CK ( P < .001), CK-MB ( P = .01), and NT-proBNP 24-hour post-intervention ( P < .02) were significantly lower in rh-proUK group than those in tirofiban group and the sum-STR right after the intervention ( P < .03) of rh-proUK group was significantly higher than that of tirofiban group. No significant difference was detected between the 2 therapies regarding major adverse cardiac events (MACE). The findings outlined in the current study showed that the improvement effect of rh-proUK on blood flow condition was stronger right after the intervention and the therapy had a similar safety when compared with tirofiban during a 30-day follow-up.

The effects of Anisodamine-Tirofiban Combined Therapy in acute myocardial infarction treated with Percutaneous Coronary Intervention (PCI)

“…All patients received conventional angiotensin converting enzyme inhibitors (ACEI) or other statin lipid-lowering drugs after the surgery. Observational Indexes: TIMI flow grades: 9 Postoperative contrast examinations were carried out to the coronary artery of the patients. If the contrast agent successfully went through the distal vascular bed at the occlusion of the coronary artery, or the blood flow velocities at the coronary artery lesion and in the forward blood vessel were consistent, it was judged as "total perfusion, grade 3"; if the contrast agent successfully went through the lesion of coronary artery and the distal vascular bed of the lesion was completely exposed, and the proximal blood vessel showed a coronary artery bed, it was judged as "partial perfusion, grade 2"; if the contrast agent completely went through the lesion of the coronary artery, but no imaging is found in the distal or proximal end of the occlusion, the result was judged as "through, but no perfusion, grade 1"; if the contrast agent does not went through the occlusion, it was judged as "no perfusion, grade 0".…”

Safety and efficacy of intracoronary recombinant human prourokinase administration in patients with acute myocardial infarction and ST‑segment elevation: A meta‑analysis of randomized controlled trials

“…Studies show that Pro-UK presents with fewer hemorrhagic complications and lower re-occlusion rate in patients with acute STEMI compared with conventional drugs ( 9 , 10 ). In addition, certain prospective study found that Pro-UK decreases MACEs whereas a retrospective study revealed that Pro-UK does not affect MACEs ( 11 ). To date, Pro-UK is not a frequent agent applied to patients for acute STEMI due to lack of evidence.…”

“…To date, Pro-UK is not a frequent agent applied to patients for acute STEMI due to lack of evidence. To the best of our knowledge, there are limited studies investigating the efficacy and safety of Pro-UK in patients with acute STEMI ( 11 , 12 ). Therefore, further investigations are needed to assess intracoronary administration of Pro-UK and non-Pro-UK treatment in patients with acute STEMI.…”