Efficacy And Safety Of Prourokinase Thrombolysis Combined With Low-dose Tirofiban In Patients With Acute ST-segment Elevation Myocardial Infarction

Objective: To investigate the efficacy and safety of prourokinase thrombolysis combined with low-dose tirofiban in patients with acute ST-segment elevation myocardial infarction?Methods: A total of 60 patients with STEMI undergoing prourokinase thrombolysis combined with low-dose tirofiban admitted to the Department of Cardiology in the Second Hospital of Hebei Medical University from January 2019 to October 2019 were enrolled in the study.All patients were given thrombolytic therapy with prourokinase 50 mg within the thrombolytic time window.The selected patients were randomly divided into a study group(30 cases)and a control group(30 cases).After allowed the informed consent of relationships of patients,the study group patients were given a bolus of 10?g/kg of tirofiban hydrochloride within 3 minutes,and then continuous intravenous infusion of 0.075?g/(kg.min)for 48 h.Basic medications in both groups: dual antiplatelet therapy(DAPT),unfractionated heparin(Monitoring ACT,the study group maintains ACT 200-250 s,the control group maintains ACT 250-300 s,usually 48 hours),low molecular heparin 5000 u subcutaneous injection 2 days(after discontinuing unfractionated heparin).Other basic medications included: Nitrates?ACEI/ARB?Statin??-blocker and so on were administrated in all the patients by conventional.Collect and record in detail the basic clinical data(sex ratio,age composition,weight and whether it is associated with risk factors for coronary heart disease,etc.)in the two groups of patients,and observe the infarct-related recanalization,myocardial perfusion,cardiac function and Impact of myocardial infarction area and incidence of complications such as bleeding.All the data were processed by SPSS22.0 software and P <0.05 as the node with statistical significance.Results: A total of 60 cases were selected for this study,including 30 in the study group and 30 in the control group.Baseline clinical data of the two groups of patients such as gender,age,weight,combined basic diseases,basic medications,cardiac function Killip classification,hemoglobin and serum creatinine levels,etc.There were no significant differences(all P>0.05).There were no significant differences in the distribution of infarct-related blood vessels,infarct sites,and multivessel disease between the two groups(all P>0.05).The preoperative TIMI blood flow classification status was similar in the study group and the control group(P>0.05),but the recanalization rate increased(90.0% vs.83.3%).Compared with the control group,the preoperative CTFC and thrombus load scores in the study group were significantly reduced(23.93±3.90 vs.28.20±8.02,0.90±1.35 vs.2.07±1.98,both P<0.05).The percentage of preoperative TMPG level 2-3 in the study group was significantly higher than that in the control group(90.0% vs.56.7%,P<0.05).There was no significant difference in the proportion of postoperative TIMI level 3 blood flow between the two groups(P>0.05),but the proportion of postoperative TMPG level 3 in the study group was significantly higher than that in the control group(93.3% vs.73.3%,P=0.038).There was no significant difference in the proportion of postoperative no reflow between the two groups(P>0.05).There were no significant differences in the number of stent implants,the length of the stent,the minimal lumen diameter,and the volume of contrast medium between the two groups(all P>0.05).There was no significant difference in left ventricular function(LVEF,LVEDD,E/A,E/E')between the two groups(all P>0.05).Compared with the control group,the peak values of CK-MB and c Tn I in the study group were significantly reduced(197.30±53.50 vs.228.60±57.60,85.40±8.72 vs.91.32±8.89,both P<0.05).No severe TIMI bleeding occurred in either group.The incidence of mild TIMI bleeding in the study group(2 cases of gross hematuria,2 cases of vomiting)was slightly higher than that of the control group(1 case of gross hematuria,1 case of vomiting)(13.3% vs.6.7%,P=0.389),but the difference was not statistically significant.The incidence of TIMI microbleeds in the study group(5 cases of skin and mucosal bleeding,1 case of nasal mucosal bleeding)was slightly higher than that of the control group(2 cases of skin mucosal bleeding,1 case of nasal mucosal bleeding)(20.0% vs.10.0%,P=0.278),but the difference was not statistically significant.There was no significant difference in the incidence of MACEs between the two groups of patients(all P>0.05).Conclusions: Prourokinase thrombolysis combined with low-dose tirofiban in patients with acute ST-segment elevation myocardial infarction can increase IRA reconnection rate,improve myocardial perfusion,reduce thrombus load,reduce myocardial infarction area and not significantly increase the risk of bleeding and MACEs events.