Effect Of Early Injection Recombinant Human Prourokinase Via Perforated Balloon On Coronary Blood Flow In Myocardial Infarction

Objective:The use of intracoronary thrombolysis in primary percutaneous coronary intervention(pPCI)is supported by limited evidence,and precision intracoronary thrombolysis is infrequently used.This study aimed to assess the effectiveness of intraoperative injection of recombinant human prourokinase(rhPro-UK),delivered via a modified non-compliant balloon converted into a foramen balloon,into a proximal local treatment of the target lesion of myocardial infarction,using a half-dose intravenous loading of rhPro-UK.Methods:A total of 90 STEMI patients who underwent pPCI at the Department of Cardiology of Anqing Municipal Hospital between December 2020 and August 2022 were randomly assigned to three groups:the intracoronary rhPro-UK group(n=22),tirofiban group(n=44),and normal saline group(n=24),in a ratio of 1:2:1.For each patient,rhPro-UK(10 ml,concentration of 1 mg/ml),tirofiban(10 ml,concentration of 50 μg/ml),or normal saline(10 ml)was injected into the proximal part of the target vascular lesion via the foramen balloon.The surgeon performed stent implantation based on the patient’s coronary artery lesion.The study primarily focused on observing the myocardial blood perfusion indexes after PCI,including thrombolysis in myocardial infarction(TIMI)blood flow grading and corrected TIMI Frame Count(cTFC),to assess whether transforamen balloon injection of rhPro-UK can improve microcirculatory function.In addition,postoperative peak levels of CK,CKMB,and soluble form suppression of tumorigenicity 2(sST2)were monitored to evaluate the efficacy of recombinant human urokinase injection through a perforated balloon in reducing myocardial infarction size and improving prognosis.The study also measured sST2 one month after surgery,left ventricular ejection fractions(LVEF)using cardiac ultrasound,and major adverse cardiovascular events(MACE)within 6 months after surgery.Results:There were no significant differences in clinical baseline data,basic information related to interventional surgery,and medication after discharge among the three groups(P>0.05).Additionally,there were no significant differences in the number of preoperative interventional procedures,immediate TIMI blood flow,and preoperative cTFC between the three groups(P>0.05).Regarding the final TIMI blood flow after PCI surgery,both the rhPro-UK group(P=0.012)and the tirofiban group(P=0.036)exhibited significantly better results than the saline group,with the rhPro-UK group being similar to the tirofiban group(P>0.05).The comparison between the cTFC in PCI immediately showed that both the rhPro-UK group(P<0.001)and the tirofiban group(P=0.003)significantly reduced the number of cTFC compared with the saline group.Furthermore,the rhPro-UK group improved the slow/no recurrent situation under the cTFC consideration criteria better than the tirofiban group(P=0.013).The comparison results of cTFC in final imaging after PCI showed that the rhPro-UK group still obtained significantly better cTFC than the saline group(P=0.015).In terms of the peak value of CKMB in the perioperative period,both the rhPro-UK group(P=0.047)and the tirofiban group(P=0.005)showed significantly lower values than those in the saline group.During the follow-up period,there was no significant difference in LVEF at one month after surgery among the three groups(P>0.05).However,the sST2 value in the rhPro-UK group was significantly lower than that in the saline group at 1 month after the operation(P=0.03).Finally,the incidence of MACE was lower in the rhPro-UK group at 6 months postoperatively,although there was no significant difference among the three groups(P>0.05).Conclusion:Administering an intracoronary injection of rhPro-UK into a foramen balloon during emergency percutaneous coronary intervention(PCI)for patients experiencing ST-segment elevation myocardial infarction(STEMI)has been shown to effectively reduce intracoronary slow or no reflow.This intervention also has the potential to enhance myocardial perfusion,decrease the size of myocardial infarction,mitigate ventricular remodeling,and ultimately improve patient outcomes.