Clinical study of the efficacy of intracoronary injections of low-dose prourokinase through the tail of the balloon on acute ST-segment elevation myocardial infarction patients undergoing percuteneous coronary intervention

doi:10.3969/j.issn.1004-583X.2024.06.006

Abstract

Abstract:

Objective To explore the clinical effect of the intracoronary injections of low-dose prourokinase through the tail of the ballon on acute ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI). Methods A total of 122 acute STEMI patients with onset within 12 h, and emergency coronary thrombosis in infarct-related artery (IRA) with thrombus score≥4 who visited the Chest Pain Center of Tianjin Baodi Hospital from June 2022 to July 2023 were recruited. They were randomly assigned into the observation group (n=61, intracoronary injections of low-dose prourokinase and tirofiban through the tail of the ballon) and control group (n=61, intracoronary injections of tirofiban through the tail of the ballon). Clinical data of the two groups were compared. Results There were no significant differences in the age, sex, smoking history, hypertension history, diabetes history, family history of coronary heart disease, history of previous myocardial infarction, hyperlipidemia history, cardiac function classification, preoperative thrombolysis in myocardial infarction (TIMI) flow grade, TIMI myocardial perfusion grade (TMPG), preoperative laboratory testing (including creatine kinase MB [CK-MB], high-sensitive cardiac troponin T [hs-cTnT], C -reactive protein [CRP], D-dimer, B-type natriuretic peptide [BNP], creatinine, hemoglobin), IRA, number of diseased vessels, symptom to reperfusion time, and thrombus load between the two groups (P>0.05). No significant differences were found between the groups in TIMI flow grade, TMPG, and incidences of major adverse cardiovascular events (MACEs) and bleeding after PCI (P>0.05). The rate of reduced ST-segment elevation (STR%) of less than 50% (≤50%) at 2 h, peak values of hs-cTnT and CK-MB, and BNP at 24 h postoperatively were significantly lower in the observation group than those of control group, while the left ventricular ejection fraction at 1 week postoperatively was significantly higher (P<0.05).Conclusion Intracoronary injections of low-dose prourokinase through the tail of the ballon reduces myocardial damage and improves cardiac function in acute STEMI patients with severe thrombus load, without increasing the risk of bleeding during hospitalization.

Key words: ST-segment elevation myocardial infarction, percutaneous coronary intervention, recombinant Human Prourokinase for Injection, tirofiban hydrochloride, intracoronary injection

CLC Number:

R542.22

Li Yanan, Zhang Hongyu. Clinical study of the efficacy of intracoronary injections of low-dose prourokinase through the tail of the balloon on acute ST-segment elevation myocardial infarction patients undergoing percuteneous coronary intervention[J]. Clinical Focus, 2024, 39(6): 518-523.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2024.06.006

https://huicui.hebmu.edu.cn/EN/Y2024/V39/I6/518

Figures/Tables 7

References 22

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项目	研究组(n=61)	对照组(n=61)	χ²/Z/t值	P值
年龄(岁)	58.61±13.34	59.93±13.04	1.441	0.155
高血压病史[例(%)]	41(67.2)	37(60.7)	0.569	0.451
男性[例(%)]	40(65.6)	38(62.3)	0.036	0.850
糖尿病病史[例(%)]	22(36.1)	27(44.3)	0.927	0.357
高脂血症[例(%)]	15(24.6)	10(16.4)	1.258	0.262
吸烟史[例(%)]	28(45.9)	18(29.5)	3.490	0.062
陈旧性心肌梗死[例(%)]	10(16.4)	14(22.9)	0.893	0.375
冠心病家族史[例(%)]	19(31.1)	28(45.9)	1.697	0.095
Killip分级≥2级[例(%)]	4(6.5)	4(6.5)	0.000	1.000
血肌酐(μmol/L)	78.15±19.98	90.59±83.69	1.102	0.275
血红蛋白(g/L)	145.41±14.39	143.84±11.53	-0.634	0.529
CRP(mg/L)	2.50(2.50, 3.65)	2.55(2.50, 2.55)	-0.866	0.387
D-二聚体(mg/L)	0.38(0.25, 0.50)	0.43(0.19, 0.58)	-0.711	0.477
BNP(pg/ml)	23.40(13.50, 95.40)	29.90(13.50, 139.30)	-0.768	0.443
CK-MB(U/L)	3.32(1.62, 14.38)	7.60(2.01, 13.90)	-1.367	0.172
hs-cTnT(ng/L)	3.13(3.13, 3.25)	3.13(0.04, 30.99)	-0.168	0.866
IRA[例(%)]
LAD	28(45.9)	30(49.2)
LCX	5(8.2)	9(14.7)	0.000	1.000
RCA	28(45.9)	22(36.1)
病变支数[例(%)]
单支	56(91.8)	55(90.2)
双支	3(4.9)	2(3.3)	0.000	1.000
三支	2(3.3)	4(6.5)
梗死部位[例(%)]
前壁其他	23(37.7) 38(62.3)	26(42.6) 35(57.4)	0.307	0.580
血栓负荷[例(%)]
血栓积分4分血栓积分5分	37(60.7) 24(39.3)	46(75.4) 15(25.6)	2.412	0.120
TIMI血流分级[例(%)]
0级	28(45.9)	32(52.5)
1级	5(8.2)	2(3.3)	3.744	0.290
2级	6(9.8)	2(3.3)
3级	22(36.1)	25(41.0)
TMPG血流分级[例(%)]
0级	60(98.4)	59(96.7)
1级	1(1.6)	2(3.3)	0.000	1.000
2级	0(0.0)	0(0.0)
3级	0(0.0)	0(0.0)
症状至再灌注时间(min)	257.82±145.72	254.38±164.31	-0.128	0.899

项目	研究组(n=61)	对照组(n=61)	χ²/Z/t值	P值
年龄(岁)	58.61±13.34	59.93±13.04	1.441	0.155
高血压病史[例(%)]	41(67.2)	37(60.7)	0.569	0.451
男性[例(%)]	40(65.6)	38(62.3)	0.036	0.850
糖尿病病史[例(%)]	22(36.1)	27(44.3)	0.927	0.357
高脂血症[例(%)]	15(24.6)	10(16.4)	1.258	0.262
吸烟史[例(%)]	28(45.9)	18(29.5)	3.490	0.062
陈旧性心肌梗死[例(%)]	10(16.4)	14(22.9)	0.893	0.375
冠心病家族史[例(%)]	19(31.1)	28(45.9)	1.697	0.095
Killip分级≥2级[例(%)]	4(6.5)	4(6.5)	0.000	1.000
血肌酐(μmol/L)	78.15±19.98	90.59±83.69	1.102	0.275
血红蛋白(g/L)	145.41±14.39	143.84±11.53	-0.634	0.529
CRP(mg/L)	2.50(2.50, 3.65)	2.55(2.50, 2.55)	-0.866	0.387
D-二聚体(mg/L)	0.38(0.25, 0.50)	0.43(0.19, 0.58)	-0.711	0.477
BNP(pg/ml)	23.40(13.50, 95.40)	29.90(13.50, 139.30)	-0.768	0.443
CK-MB(U/L)	3.32(1.62, 14.38)	7.60(2.01, 13.90)	-1.367	0.172
hs-cTnT(ng/L)	3.13(3.13, 3.25)	3.13(0.04, 30.99)	-0.168	0.866
IRA[例(%)]
LAD	28(45.9)	30(49.2)
LCX	5(8.2)	9(14.7)	0.000	1.000
RCA	28(45.9)	22(36.1)
病变支数[例(%)]
单支	56(91.8)	55(90.2)
双支	3(4.9)	2(3.3)	0.000	1.000
三支	2(3.3)	4(6.5)
梗死部位[例(%)]
前壁其他	23(37.7) 38(62.3)	26(42.6) 35(57.4)	0.307	0.580
血栓负荷[例(%)]
血栓积分4分血栓积分5分	37(60.7) 24(39.3)	46(75.4) 15(25.6)	2.412	0.120
TIMI血流分级[例(%)]
0级	28(45.9)	32(52.5)
1级	5(8.2)	2(3.3)	3.744	0.290
2级	6(9.8)	2(3.3)
3级	22(36.1)	25(41.0)
TMPG血流分级[例(%)]
0级	60(98.4)	59(96.7)
1级	1(1.6)	2(3.3)	0.000	1.000
2级	0(0.0)	0(0.0)
3级	0(0.0)	0(0.0)
症状至再灌注时间(min)	257.82±145.72	254.38±164.31	-0.128	0.899

组别	例数	TIMI血流分级[例(%)]		TMPG血流分级[例(%)]
组别	例数	0~2级	3级	0~2级	3级
研究组	61	2(3.3)	59(96.7)	3(4.9)	58(95.1)
对照组	61	2(3.3)	59(96.7)	6(9.8)	55(90.2)
χ²值		0.000		1.080
P值		1.000		0.299

组别	例数	TIMI血流分级[例(%)]		TMPG血流分级[例(%)]
组别	例数	0~2级	3级	0~2级	3级
研究组	61	2(3.3)	59(96.7)	3(4.9)	58(95.1)
对照组	61	2(3.3)	59(96.7)	6(9.8)	55(90.2)
χ²值		0.000		1.080
P值		1.000		0.299

组别	例数	STR[例(%)]
组别	例数	≤50%	>50%
研究组	61	6(9.8)	55(90.2)
对照组	61	17(27.9)	44(72.1)
χ²值		6.483
P值		0.011