Abstract
Background: To determine whether intracoronary pro-urokinase or tirofiban improves myocardial reperfusion during primary percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI).Methods: The study included patients with acute STEMI presenting within 12 h of symptoms at 11 hospitals in China between November 2015 and July 2017. Patients were randomized to receive selective intracoronary infusion of recombinant pro-urokinase (20 mg), tirofiban (10 μg/kg), or saline (20 mL) proximal to the infarct-related lesion over a 3-min period before stent implantation during primary PCI. The primary outcome was final corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC) after PCI.Results: This study included 345 patients. Initial angiography identified a high-grade thrombus (TIMI 4–5) in 80% of patients. Final CTFC after PCI was significantly lower in the pro-urokinase (P < 0.001) and tirofiban (P < 0.001) groups than in the saline group and similar between the pro-urokinase and tirofiban groups (P > 0.05). The pro-urokinase (P = 0.008) and tirofiban groups (P = 0.022) had more complete ST-segment resolution at 2 h and lower peak creatine kinase-MB levels after PCI than the saline group (P = 0.006 and P = 0.023). The 30-day incidence of major adverse cardiac events was 4.5% in the pro-urokinase group, 3.4% in the tirofiban group, and 2.6% in the saline group. The incidence of in-hospital TIMI major bleeding events was low and comparable between groups.Conclusions: Adjunctive intracoronary pro-urokinase or tirofiban given before stent implantation during primary PCI improves myocardial reperfusion without increasing the incidence of major bleeding events.
Highlights
Ischemic heart disease (IHD) due to atherosclerosis is an important cause of morbidity and hospitalization worldwide [1] and responsible for around 9 million deaths annually [2]
A total of 374 patients with segment elevation myocardial infarction (STEMI) scheduled for primary percutaneous coronary intervention (PCI) were screened for inclusion, and 29 patients were subsequently excluded from the study (TIMI flow grade 3 in the infarctrelated artery, n = 12; presented >12 h after symptom onset, n = 10; prior intravenous thrombolysis, n = 1; and failure to meet other inclusion criteria, n = 6)
There were no significant differences between the three groups in age, gender, body mass index, smoking history, medical history, heart rate, systolic or diastolic blood pressure, infarct location, hemoglobin level, platelet count, or serum creatinine concentration (Table 1)
Summary
Ischemic heart disease (IHD) due to atherosclerosis is an important cause of morbidity and hospitalization worldwide [1] and responsible for around 9 million deaths annually [2]. Rupture of an atherosclerotic plaque and subsequent thrombus formation leads to a reduction in blood flow through a coronary artery that causes acute coronary syndrome, which is a disease spectrum that includes ST-segment elevation myocardial infarction (STEMI). Myocardial revascularization is key to the treatment of STEMI [7], and the revascularization procedures available include coronary artery bypass grafting and percutaneous coronary intervention (PCI) [8]. Primary PCI to reopen the occluded coronary artery is the evidence-based standard of care for patients with acute STEMI [9]. Studies during the last decade have suggested that intracoronary administration of a glycoprotein IIb/IIIa inhibitor during primary PCI can improve myocardial reperfusion and clinical outcomes in patients with STEMI [14–19]. To determine whether intracoronary pro-urokinase or tirofiban improves myocardial reperfusion during primary percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI)
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