Effects On Myocardial Microperfusion With Target Intravascular Injection Of Prourokinase In Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Acute myocardial infarction(AMI)is acute necrotic due to myocardial persistent ischemia while the coronary flow sharply reduce or interrupt,it is common in Europe and the United States.In the United States,1.5million patients suffer from myocardial infarction.In our country,with the improvement of people's living and medical conditions,Aging problem become more and more serious,the morbidity of AMI also increases year by year.At present,the patient with myocardial infarction has amounted to2.5 million,AMI is urgent and severe disease and seriouly threaten to people's life and health because of high mortality and making younger.In recent years,reperfusion therapy were widely used such as thrombolysis therapy,percutaneous coronary interention(PCI)and coronary artery bypass grafting(CABG),so that myocardial ischemia has effectively regain blood supply in the AMI patient,PCI is the main measures to treat AMI.But,in a part of patients,infarct-related artery(IRA)have been reperfusion effectively,the myocardial microvascular do not get full reflow,and myocardial tissue has also not been effectively perfused,that is to say no reflow phenomenon(NRP)which will increase major adverse cardiovascular events(MACE)and affect the prognosis seriously.Therefore,reperfusion of myocardial microvascular has been paid closeattention in clinic.As new thrombolytic drug,prourokinase is the specific plasminogen activator,and it can directly activate plasminogen on the surface of blood clots,make it into plasmin,to dissolve specificly thrombosis.it do not affect body's fibrinolytic system,so the risk of bleeding significantly reduce.In this study,patients with AMI were injected prourokinase to target vascular in PCI,we observe the myocardial microperfusion.A total of 60 AMI patients who underwent primary PCI were randomly divided into prourokinase group(30 cases)and control group(30cases),all patients chewed aspirin 300 mg,clopidogrel 300 mg and atorvastatin 80 mg,received intravenous injection heparin sodium 100IU/Kg before PCI.coronary angiography was performed immediately after stent implantation,control group were injected anisodamine 200?g to target vascular by OTW balloon,injecting three times,interval for three minutes each time,coronary angiography was done in ten minutes.The prourokinase group received injecting 5mg prourokinase to target vascular by OTW balloon after the first injection of anisodamine(dissolved in 10 ml normal saline,injected for 5 minutes),then completed the other two anisodamine injection in the same way,coronary angiography was done in ten minutes.We observed the corrected TIMI grading(CTFC)difference of stent implantation immediately angiogram and the last angiogram between two groups.In result,the basic clinical date between two groups had no significant differences(P>0.05).the preoperative coronary angiogram data between two groups had no significant differences(P>0.05).comparison of CTFC difference of the stent implantation immediately angiogram and the last angiogram between two groups,prourokinase group[4.00(4.82)]was obviously more than control group[2.00(3.00)],there was significant differences(P<0.05).comparison of haemorrhagic complication between two groups,there was not significant differences(P>0.05).The above results suggest that injection prourokinase to target vascular of AMI paients who undergo PCI can improve myocardial microperfusion and may not increase the risk of bleeding.