Efficacy and safety of intracoronary prourokinase during percutaneous coronary intervention in treating ST-segment elevation myocardial infarction patients: a randomized, controlled study

Abstract

Background: Prourokinase is a single-chain plasminogen activator presenting with fewer hemorrhagic complications and reduced reocclusion rate compared with the conventional fibrinolytic agents in patients with coronary artery disease. However, prourokinase intracoronary injection during PCI for treating patients with STsegment elevation myocardial infarction (STEMI) is rarely investigated. Therefore, this study aimed to evaluate the efficacy and safety of intracoronary prourokinase during the percutaneous coronary intervention (PCI) in treating STEMI patients. Methods: Fifty STEMI patients who underwent primary PCI were consecutively enrolled and randomly assigned to intracoronary prourokinase group (N = 25) or control group (N = 25). During the primary PCI procedure, patients in the intracoronary prourokinase group received 10 ml prourokinase injection, while patients in control group received 10 ml saline injection as control. The primary endpoints were coronary physiological indexes, the secondary endpoints were angiographic assessments, myocardial infarct size/reperfusion assessment, cardiac function evaluations, major adverse coronary events (MACEs) and hemorrhagic complications. All patients were followed up for 3 months.

Intracoronary pharmacological therapy versus aspiration thrombectomy in STEMI (IPAT-STEMI): A systematic review and meta-analysis of randomized trials

“…The 12 trials enrolling 1,466 patients were conducted in different countries between 2009 and 2018. Six studies recruiting 647 patients (44.1%) were from China [ 77 , 79 , 80 , 85 , 86 , 88 ]. Recruitment periods ranged from 0.5 to 5.4 years and sample size from 39 to 452 patients.…”

“…The prevalence of hypertension, diabetes and smoking status was 15–82%, 7.9–68.9%, and 25–84%, respectively. The proportions of patients with angiography-determined multivessel disease ranged from 0% to 88% [ 77 , 78 , 80 , 81 , 85 , 88 ]. The left anterior descending (LAD) artery was the infarct-related artery in 32% to 80% of patients in six studies [ 78 , 80 – 82 , 85 , 88 ].…”

“…The proportions of patients with angiography-determined multivessel disease ranged from 0% to 88% [ 77 , 78 , 80 , 81 , 85 , 88 ]. The left anterior descending (LAD) artery was the infarct-related artery in 32% to 80% of patients in six studies [ 78 , 80 – 82 , 85 , 88 ]. Five studies enrolled patients with anterior STEMI only ( Table 2 ) [ 79 , 83 , 84 , 86 , 87 ].…”

“…Door-to-balloon time ranged from 17.8 to 120 minutes. Radial access during coronary angiography was used in four studies [ 77 , 80 , 84 , 86 ], femoral in two [ 78 , 87 ], and the access approach was not stated in the remaining ones. As a result of identifying various pharmacological interventions, the studies were divided into three groups; thrombolytics (Group 1), GPI (Group 2), and GPI plus AT (Group 3).…”

“…The main comparisons included thrombolytics versus AT, GPI versus AT, and GPI plus AT versus AT. Four studies administered thrombolytic agents (prourokinase, urokinase) [ 77 – 80 ], three investigated GPI (abciximab, eptifibatide, tirofiban) [ 81 – 83 ], and five combined GPI with AT [ 84 – 88 ]. The latter group has subgroups from two studies included in Group 2 [ 81 , 83 ] Two [ 78 , 79 ] of four studies in Group 1 have used thrombolytic agent plus AT, and one study [ 79 ] used intracoronary urokinase with tirofiban.…”