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A randomized study of prourokinase during primary percutaneous coronary intervention in acute ST-segment elevation
Wei Geng1, Qi Zhang1, Jingmin Liu1
1Department of Cardiology, Baoding First Central Hospital, Baoding, Hebei, China.
Insights
Intracoronary prourokinase improved myocardial perfusion in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). This treatment showed better ST-segment resolution and myocardial blood flow without increasing bleeding risk.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomedical Engineering
Background:
- ST-segment elevation myocardial infarction (STEMI) is a critical condition requiring rapid reperfusion.
- Primary percutaneous coronary intervention (PCI) is the standard treatment for acute STEMI.
- Optimizing myocardial reperfusion during primary PCI remains a key therapeutic goal.
Purpose of the Study:
- To assess the efficacy and safety of intracoronary prourokinase administration during primary PCI in STEMI patients.
- To evaluate the impact of intracoronary prourokinase on myocardial perfusion and infarct size.
- To compare the incidence of hemorrhagic complications and major adverse cardiac events (MACE) between treatment groups.
Main Methods:
- A randomized controlled trial involving 230 STEMI patients undergoing primary PCI.
- Patients were assigned to receive either intracoronary prourokinase (IP group, n=118) or saline (control group, n=112) via balloon catheter.
- Key outcomes included ST-segment resolution, myocardial blood flow (MBF), cardiac biomarkers, bleeding complications, and MACE at 6-month follow-up.
Main Results:
- The IP group demonstrated significantly higher rates of complete ST-segment resolution (>70%) compared to the control group.
- Patients receiving intracoronary prourokinase exhibited lower serum levels of CK, CK-MB, and TnI, alongside significantly improved MBF.
- No significant differences in TIMI major or minor bleeding complications were observed; a trend towards reduced MACE in the IP group did not reach statistical significance.
Conclusions:
- Intracoronary administration of prourokinase via balloon catheter during primary PCI is effective in improving myocardial perfusion in STEMI patients.
- This approach enhances ST-segment resolution and myocardial blood flow without a significant increase in bleeding risk.
- Further research may explore the long-term impact of prourokinase on MACE in STEMI patients.
Objectives:
To evaluate the efficacy and safety of intracoronary administration of prourokinase via balloon catheter during primary percutaneous coronary interventions (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI).
Methods:
Acute STEMI patients underwent primary PCI were randomly divided into two groups: intracoronary prourokinase (IP) group (n = 118) and control group (n = 112). During primary PCI, prourokinase or saline were injected to the distal end of the culprit lesion via balloon catheter after balloon catheter dilatation. Demographic and clinical characteristics, infarct size, myocardial reperfusion, and cardiac functions were evaluated and compared between two groups. Hemorrhagic complications and MACE occurred in the 6-months follow up were recorded.
Results:
No significant differences were observed between two groups with respect to baseline demographic, clinical, and angiographic characteristics (P > 0.05). In IP group, more patients had complete ST segment resolution (>70%) compared with control group (P < 0.05). Patients in IP group showed lower levels of serum CK, CK-MB and TnI, and a much higher myocardial blood flow (MBF) than those in control group (P < 0.05). No significant differences of TIMI major or minor bleeding complications were observed between the two groups (P > 0.05). At 6-months follow-up, there was a trend that patients in the IP group had a less chance to have MACE, though it was not statistically different (8.5% vs 12.5%, P > 0.05).
Conclusions:
Intracoronary administration of prourokinase via balloon catheter during primary PCI effectively improved myocardial perfusion in STEMI patients.
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