Prognosis in Patients with ST-Segment Elevation Myocardial Infarction Reperfused by PHDP: 1-Year MACEs Follow-Up

Area of Science:

• Cardiology
• Interventional Cardiology
• Emergency Medicine

Background:

• Acute ST-segment elevation myocardial infarction (STEMI) requires rapid reperfusion to minimize myocardial damage.
• Pharmacoinvasive strategies offer an alternative or adjunct to primary percutaneous coronary intervention (PPCI).

Purpose of the Study:

• To evaluate the 1-year outcomes of a pharmacoinvasive strategy using half-dose recombinant human prourokinase (PHDP) compared to PPCI in STEMI patients.
• To assess major adverse cardiovascular events (MACEs) and postoperative bleeding at 30 days and 1 year.

Main Methods:

• A comparative study involving 150 STEMI patients, randomized into PHDP (n=75) and PPCI (n=75) groups.
• Key metrics included FMC-reperfusion time, procedural interventions, intraoperative complications, and 30-day and 1-year clinical follow-up for MACEs and bleeding.

Main Results:

• The PHDP group demonstrated significantly shorter FMC-reperfusion times (42.00 min vs. 96.00 min, P < 0.001).
• PHDP group showed reduced use of percutaneous transluminal coronary angioplasty (PTCA), intropin, and tirofiban during PCI.
• Lower incidence of intraoperative arrhythmia, malignant arrhythmia, and slow flow/no-reflow was observed in the PHDP group (P < 0.001).
• At 30 days, PPCI group had higher readmissions for unstable angina (P = 0.037).
• No significant difference in 1-year MACEs (P = 0.500) or postoperative bleeding (major, intracranial, minor) between groups (P > 0.05).

Conclusions:

• The PHDP strategy facilitates early treatment of infarct-related vessels and shortens FMC-reperfusion time in STEMI patients.
• PHDP is associated with fewer intraoperative complications and reduced need for adjunctive PCI procedures.
• This approach does not increase the risk of MACEs or bleeding events at 1-year follow-up compared to PPCI.