Comparative Study Of The Effects Of Recombinant Human Prourokinase On Preoperative Vein And Intraoperative Coronary Artery In Patients With Acute ST-segment Elevation Myocardial Infarction

Objective:At present,there is a lack of clinical studies on the effects of recombinant human prourokinase in the preoperative and intraoperative coronary artery in patients of acute ST-segment elevationl infarction.Therefore,it is necessary to study the clinical efficacy and safety of recombinant human prourokinase combined with PCI in the treatment of acute ST-segment elevation myocardial infarction,in order to find a treatment strategy to optimize early reperfusion of acute ST-segment elevation myocardial infarction.Method:All the selected patients were from patients of acute ST-segment elevation infarction admitted to our department of emergency medicine and cardiology from January 2015 to January 2018.The randomized digital table method was used to randomly divide 120 patients into the observation group and the control group.The observation group was the early PCI group after intravenous thrombolysis,and the control group was intracoronary thrombolysis combined with PCI group.Immediately after treatment,the observation group was given aspirin 300 mg and clopidogrel 300mg,the control group was given aspirin 300 mg and clopidogrel 600 mg;followed by aspirin 100 mg once daily,clopidogrel 75 mg once daily for maintenance;nitrates,Beta-adrenergic receptor antagonist,angiotensin converting enzyme inhibitors,Statins were given according to the condition.The observation group was treated with recombinant human prourokinase for intravenous thrombolysis,Pro-uk20 mg+saline 10 ml intravenous bolus(within 3 mins),the remaining 30 mg+saline 90 ml,and the instillation was completed within 30 mins.Coronary angiography(CAG)is prepared at the same time as thrombolysis.If the infarct-related stenosis was still more than 75%or the blood flow did not reach TIMI3,early PCI was performed.The control group underwent intracoronary infusion of recombinant human prourokinase 20 mg+nitroglycerin 200 ug mixture in PCI,and then routine PCI.Coronary angiography was performed in all patients,and the ST segment fallback,the distribution of TIMI blood flow grading,the peak value of creatine kinase isoenzyme(CK-MB)and the value of NT-proBNP were counted.The patients were followed up for 3 months,to compare the two groups of patients in LVEDD,LVEF and MACEs and bleeding events.Results:1.Compared with the control group,the ST segment complete regression rate,and fallback>50%in 2 hour after PCI of the observe group were significantly higher,statistically significant(P<0.05).2.According to the results of TIMI flow grade before and after PCI,the observe group was higher than the control group,(P<0.05).3.Compared with the control group,CK-MB peak in the observe group was significantly lower.(P<0.05).But there was no significant difference in the level of NT-proBNP(P>0.05).4.After 3 months follow-up period,compared with the control group,LVEDD was lower and LVEF was higher in the observe group(P<0.05),the MACEs were lower(P<0.05).The bleeding events of the two groups were similar(P>0.05).Conclusion:1.Recombinant human prourokinase can effectively reduce the occurrence of no-reflow,improve myocardial tissue perfusion and improve cardiac function in patients with acute ST-segment elevation myocardial infarction before and after intraoperative coronary artery application.2.Recombinant human prourokinase preoperative intravenous application is better than intraoperative coronary application.