| Objective Recombinant human pro-urokinase(trade name: rh-pro UK)is a new type of third generation thrombolytic drug with specificity and no antigenicity.It can selectively combine with fibrinolytic enzyme on the surface of thrombus,and then be activated and transformed into double chain urokinase,which plays the role of thrombolysis.Previous studies have shown that the application of recombinant human urokinase in patients with acute ST-segment elevation myocardial infarction is safe and can improve heart ventricle remodeling,but such studies are rare.The status of intracoronary thrombolysis remains controversial in primary percutaneous coronary intervention(PCI).The purpose of this study was to investigate the effect of thrombus aspiration combined with intracoronary rh-pro UK on interventional therapy and clinical prognosis in patients with acute anterior wall myocardial infarction who were confirmed to have severe thrombus load during primary PCI,and to provide evidence for clinical application.Methods The patients with acute anterior wall myocardial infarction were collected from January 2015 to June 2019 in Cangzhou central hospital by retrospective analysis.Inclusion criteria:(1)age < 75 years old;(2)all of them met the definition of acute ST-segment elevation myocardial infarction;(3)ST segment elevation leads ? 2 in leads V1-V4 of ECG;(4)new complete left bundle branch block;(5)within 12 hours of onset;(6)primary PCI was performed after admission,and the infarct-related artery was confirmed to be located in the proximal or middle part of left anterior descending artery during the operation;(7)severe thrombus load was confirmed by coronary angiography;(8)thrombus aspiration catheter was used during the operation.Exclusion criteria:(1)history of anterior descending stent implantation;(2)history of coronary artery bypass grafting;(3)patients with serious liver and kidney diseases or cerebrovascular diseases;(4)patients with hematopathy;(5)before primary PCI,platelet glycoprotein ? b/ ? a receptor inhibitor(tirofiban)was used;(6)thrombolysis was used before primary PCI;(7)patients with contraindications for thrombolysis;(8)the infarct-related artery was located in patients with left circumflex artery or right coronary artery.Grouping method: on the basis of the inclusion and exclusion criteria,the patients were grouped according to the following methods: group A was treated with thrombus aspiration alone during primary PCI;group B was treated with thrombus aspiration combined with intracoronary tirofiban;group C was treated with thrombus aspiration combined with intracoronary rh-pro UK.The patients were followed up for 6 months by consulting the electronic case system of inpatient or outpatient and telephone follow-up.Outcome measures:(1)cardiac magnetic resonance imaging(CMRI)results during hospitalization;(2)color Doppler echocardiography results during hospitalization,1st month and 6th month after operation;(3)end point of 6 months follow-up was major adverse cardiovascular events,including myocardial(re)infarction,cardiovascular death and target vessel revascularization.Results1.According to the inclusion and exclusion criteria,368 patients were finally selected: 121 in group A,130 in group B and 117 in group C.2.The clinical characteristics of the three groups were not significantly different(P>0.05).3.There were significant differences among the three groups in patients with TIMI myocardial perfusion grade(TMPG)< 3(12.4% vs.3.8% vs.3.4%,P=0.006).The patients with TMPG < 3 in group B and group C were significantly lower than that in group A(P<0.05).And the incidence of group C was lower than that in group B,but there was no significant difference between the two groups(P=0.858).4.The loss of follow-up in 6 months: in group A,4 cases(3.3%)lost their visit.1 case died of traffic accident,3 cases could not be connected by telephone follow-up and the case system had no revisit record;in group B,5 cases(3.8%)lost their visit.1 case died of acute pulmonary embolism,4 cases could not be connected by telephone follow-up and the case system had no further visit records;in group C,4 cases(3.4%)lost their visit.1 case died of acute pulmonary embolism,1 case died of sudden death(the specific reason was unknown),2 cases could not be connected by telephone follow-up and the case system had no further visit record.5.There were significant differences in left ventricular end-diastolic diameter(LVDD)among the three groups at the 6th month(51.6 ± 5.5 vs.49.3 ± 7.4 vs.48.8 ± 8.6,P=0.007).The LVDD in group A and group B was significantly lower than that in group A(P<0.05),but there was no statistical difference between group B and group C(P=0.852).There were significant differences in left ventricular ejection fraction(LVEF)among the three groups at the 6th month(47.7 ± 8.3 vs.49.6 ± 6.9 vs.50.2 ± 5.4,P=0.016).The LVEF in group B and group C was significantly higher than that in group A(P<0.05).The LVEF in group C was higher than in group B,but there was no statistical difference(P=0.779).6.The results of c MRI showed that there were significant differences in the area of myocardial necrosis among the three groups(16.9 ± 7.1 vs.14.3 ± 7.3 vs.14.0 ± 6.9,P=0.007).Compared with group A,the area of myocardial necrosis in group B and group C was significantly reduced(P<0.05),but there was no significant difference between group B and group C(P=0.958).7.During the follow-up period of 6 months,there was no significant difference in bleeding events(P=0.864)and no major bleeding event in all the three groups.8.There was no significant difference in the incidence of major adverse cardiovascular events(MACE)among the three groups(P>0.05).The log-rank test of survival analysis showed that there was no significant difference in MACE among the three groups(P = 0.550).Conclusions1.In patients with severe thrombus load in the proximal and middle segment of left anterior descending artery during primary percutaneous coronary intervention,the combination of thrombus aspiration catheter and intracoronary recombinant human pro-urokinase(trade name: rh-pro UK)could significantly improve the level of myocardial reperfusion.2.The combination of thrombus aspiration and intracoronary rh-pro UK or tirofiban can reduce myocardial necrosis at the level of c MRI without increasing the risk of bleeding.3.There was no significant difference in the incidence of major adverse cardiovascular events among the three groups,but the incidence of major adverse cardiovascular events in the combined treatment group was lower than that in the simple thrombus aspiration group.4.Because left ventricular remodeling is a slow process,the left ventricular end-diastolic volume and left ventricular ejection fraction obtained by color Doppler ultrasound in the two groups showed significant improvement only at the beginning of the 6th month. |
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