The Efficacy and Safety of Pharmacoinvasive Therapy with Prourokinase for Acute ST‐Segment Elevation Myocardial Infarction Patients with Expected Long Percutaneous Coronary Intervention‐Related Delay

Abstract

SUMMARYObjectives: To elucidate the efficacy and safety of pharmacoinvasive therapy by using prourokinase (prouk) in patients with ST-segment elevation myocardial infarction (STEMI). Background: Patients with STEMI often have long percutaneous coronary intervention (PCI)-related delays due to various reasons, which are associated with poor outcomes. Methods: A randomized study which enrolled patients from four centers in China was conducted. Patients were randomly assigned to accept routine primary PCI or prouk-PCI. The primary end points were the angiographic parameters, including thrombolysis in myocardial infarction (TIMI) flow grade, TIMI frame count, and myocardial blush grade. Secondary endpoints were incidence of major adverse cardiac events (MACE, defined as death from all causes, reinfarction, revascularization, or rehospitalization due to new or worsening congestive heart failure) at 30 days and 1 year. Results: One hundred and ninety-seven eligible patients were enrolled, of whom 100 were randomized to the prouk-PCI group. Significantly more patients in the prouk-PCI group than in the PCI group had an opened infarct-related artery on arrival in the catheterization laboratory (48% vs. 21%, P = 0.0002) and better TIMI frame count after PCI (33 AE 6 vs. 40 AE 10, P < 0.001). At 1-year follow-up, there was a trend that patients in the prouk-PCI group had less chances to have MACE (7.0% vs. 12.6%, P = 0.235) or be readmitted to hospital due to new or worsening congestive heart failure (1.0% vs. 4.1%, P = 0.209). Conclusion: A strategy of emergent PCI preceded by fibrinolysis with prouk results in a better myocardial perfusion in infarct-related artery compared with primary PCI alone in patients with STEMI and long PCI-related delay.Primary percutaneous coronary intervention (PCI) is an effective treatment for ST-segment elevation myocardial infarction (STEMI) when it can be performed rapidly [1]. However, this procedure may not completely prevent further myocardial damage due to reperfusion injury and distal embolization [2]. More importantly, even in the hospital with primary PCI capability, patients with STEMI often have long PCI-related delays due to various reasons, which are associated with poorer outcomes [3]. In those patients, the appropriate and timely use of reperfusion therapy is likely more important than the choice of reperfusion methods. Indeed, American College of Cardiology/American Heart Association (ACC/AHA) guidelines recognize that one reperfusion approach is not superior for all patients, in all clinical settings, at all times of day [4]. The use of facilitated PCI was shown to be detrimental compared with primary PCI, with increased ischemic and bleeding events, and a trend toward excess mortality [5,6]. Conversely, among high-risk STEMI patients, the treatment with fibrinolysis and transferred for PCI within 6 h after fibrinolysis was associated with significantly fewer ischemic complications than that in standard treatment [7]. Tissue plasminogen activator (t-PA) is the commonly use...

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

“…And in the study conducted in STEMI patients who receive intracoronary administration of prourokinase through balloon catheter during primary PCI illuminates that the proportions of patients who achieve complete ST-segment resolution, reduced levels of serum CK, CK-MB and TnI are higher than those in patients treated with PCI alone [16]. Another randomized controlled trial reveals more cases of opened infarct-related artery on arrival in the catheterization laboratory and better TIMI frame count in patients receiving PCI with prourokinase than patients receiving only PCI; in addition, at 1-year followup, this study also elucidates that patients receiving PCI with prourokinase present with a trend of less incidence of MACE and re-admission to hospital compared with patients treated by PCI alone [17]. In this randomized controlled study, we found that the STEMI patients receiving intracoronary prourokinase during PCI presented with better improvement of IMR compared with patients receiving only PCI, and the TMPG, CK peak value, CK-MB peak value, cTnI, STR as well as the 3-month LVEF, LVEDd and WMSI were also better compared with patients who received only PCI, which were in accordance with the previous trials.…”

“…Thus, boosting efficacy and safety of PCI in STEMI is constantly a major concern in clinical practice. In addition, the use of prourokinase in myocardial infarction including STEMI has been tested in various clinical trials and studies, which altogether present a good efficacy and safety of prourokinase as a thrombolytic agent [16,17]. Therefore, we performed this randomized clinical trial which evaluated the efficacy and safety of intracoronary prourokinase during PCI for STEMI treatment, and the main findings were as follows: 1) IMR was decreased in intracoronary prourokinase group compared with control group; 2) TMPG, CK peak value, CK-MB peak value, cTnI and STR were more satisfactory in intracoronary prourokinase group than those in control group; 3) the cardiac function including LVEF, LVEDd and WMSI were better in intracoronary prourokinase group compared with control group; 4) no difference regarding hemorrhagic AEs and MACE incidences was found between the two groups.…”

Influence of Oxidative Stress Markers on Coronary No-reflow After Primary Percutaneous Coronary Intervention for Patients with Acute Myocardial Infarction

“…In the study conducted by Wang et al, [21] no reflow cases were older and had higher heart rates than patients without No-reflow. They had a history of hypertension, diabetes and smoking.…”

The intracoronary injection of recombinant human prourokinase in emergency interventional therapy for high thrombus load during ST-segment elevation myocardial infarction: a retrospective cohort study

“…Previous studies have shown that [12] rhPro-UK can be injected into the coronary artery in a variety of ways, such as guiding catheters, microcatheters, suction catheters, and drug balloons. Microcatheters or suction catheters require the guide wire to be withdrawn before drug injection and for the guide wire to be reinserted during treatment, which increases the surgery time and the risk of complications; however, the new perfusion balloon is expensive, which limits its clinical application.…”