| Objective: The aim of study was to thrombolytic therapy with acute myocardial infarction(AMI) in patients by urokinase(UK),Alteaplase and reteplase, then as a parallel control with the UK,observing the Alteplase, Reteplase with the UK of different time periods of the recanalization rate of clinical standard,the degree of heart function and myocardial injury,the hospitalization complications and case fatality rate,bleeding after thrombolysis were compared to explore and evaluate the efficacy, prognosis and clinical safety for thrombolytic therapy with AMI in patients by urokinase(UK),Alteaplase and reteplase.Methods: The 176 patients who had diagnosed AMI without thrombolysis contraindications according to 2004ACC/AHA guidelines for the management of patients with AMI was selected.They were treated in the Emergency and Cardiovascular department of the Second Hospital of Hebei Medical University from October 2007 to April 2009.Eligible patients with AMI were randomizated to UK group (UK group ,n=62), Alteplase group (Alteplase group,n=44) and Reteplase group (Reteplase group,n=70) and treated respectively by UK, Alteplase and Reteplase which were intravenous thrombolytic drug.The patients were divided into the early thrombolysis group within 6 hours after onset of sympotoms and the late thrombolysis group between 7 and 12 hours after onset of sympotoms.UK was given by intravenous infusion of 1.5 million units over 30 minute. The Alteplase was administered by an intravenous bolus of 8 mg followed by infusion of 42 mg over 90 minutes. Reteplase was given first by intravenous injection of 10MU(no less than 2 minutes),and after 30 minutes, Reteplase was given by intravenous injection of 10MU again.In the Alteplase and Reteplase groups, the heparin was given by intravenous infusion of 60U/kg bolus(an average of about 4000U) before thrombolysis ,and heparin was continued to apply by intravenous infusion or micro-pump pumping of 1000U/h during 48 hours after thrombolysis,then adjusted the heparin dose to keep the activated partial thromboplastin time (APTT) value within 1.5 to 2.0 times control(50~70s).After 48 hours of completing thrombolysis,the heparin was changed to low molecule weight heParin(LMWH) by subcutaneous injection of 5000U once every 12h.In the UK group,LMWH was given by subcutaneous injection of 5000U once every 12h after 12 hours of completing thrombolysis.300mg aspirin and clopidogrel oral or chewing before thrombolysis to all the patients,followed by 300mg aspirin and 75mg clopidogrel oral a day.The patients without contraindications exit in there groups were individualized given oral beta-blockers,angiotensin-converting enzyme(ACE) inhibitors and hypolipidemic drugs.Observed the changes of the patients'symptoms and signs of in each group,and they must be to do 18-lead ECG before thrombolysis, then they also must be to do 12-lead ECG within 30min,60min,90min,120min after thrombolysis,if the patients with onset of infarction in the right ventricle, posterior wall and inferior wall should be to do18-lead ECG; the venous blood were collected for detection of myocardial enzymes within 6h,8h,12h,14h,16h,24h after thrombolysis and before thrombolysis; echocardiography was to done during 4 weeks after thrombolysis in the patients of there groups. According to these data,using different periods of the recanalization rate of clinical standard,the degree of heart function and myocardial injury,the hospitalization complications and case fatality rate during 4weeks,bleeding after thrombolysis were to evaluate the efficacy, prognosis and clinical safety for thrombolytic therapy with AMI in patients by UK,Alteaplase and reteplase. The statistical software SASv8.0 was used to analyze all data in this study. The measurement data which accord with the normal distribution by normality test were shown with mean±standard deviation( x±S) and analyzed by one-factor ANOVA,if the measurement data accord with the skewed distribution,they were shown with median±quartile range(M±QR) and analyzed by rank-sum test.The enumeration data were shown with percentage terms and analyzed by chi-square test. There was significant difference on statistics if P values less than 0.05.Results:1.The general clinical data: A total of 176 patients were selected in this study,their ages were from 33 to 84 years old(the average age is 56.26±11.07 year old) and the time from onset to thrombolysis was less than 12 hours. There was no significant difference about age, sex, the time from onset to thrombolysis, risk factors, bad habits, infarction wall, kiliip grade before thrombolysis and percutaneous coronary intervention(PCI) after thrombolysis among UK group, Alteplase group and Reteplase group (P>0.05).2.Different periods of the recanalization rate of clinical standard:The recanalization rate at 30min, 60min, 90min and 120min in UK group were 8.06%,32.26%, 53.23% and 67.74% respctively;In Alteplase group,it was 9.09%,52.27%, 2.73% and 79.55 % respctively;In Reteplase group,it was 8.57%,64.29%,81.43% and 84.29% respctively.The recanalization rate at 60min, 90min, 120min in Reteplase group and Alteplase group was respctively higher than those in UK group, then there was significantly difference in the recanalization rate between Reteplase group and UK group(P<0.01), and there was difference in the recanalization rate between Alteplase group and UK group(P<0.05).But there was no significantly difference between Alteplase group and Reteplase group(P>0.05).And there was no difference at other periods of the recanalization rate among the three groups (P>0.05).3.The hospitalization recanalization rate of clinical standard and case fatality rate in early or late thrombolysis:In UK group, the recanalization rate in early and late thrombolysis were 74.00% vs 33.33% and the case fatality rate in the hodpital were 6.00% vs 25.00% respctively;In Alteplase group, the recanalization rate in early and late thrombolysis were 85.29% vs 70.00% and the case fatality rate in the hodpital were 5.88% vs 10.00% respctively;In Reteplase group, the recanalization rate in early and late thrombolysis were 87.50% vs 77.27% and the case fatality rate in the hodpital were 4.17%, 9.09% respctively.The recanalization rate of patients in three groups in early thrombolysis was higher than those of the same group in late thrombolysis, and the case fatality rate in the hodpital of patients in three groups in early thrombolysisin was lower than those of the same group in late thrombolysis.Then there was significantly difference in UK group between two time stages(P<0.05),while there was no significantly difference in other groups between two time stages (P>0.05).But, there was significantly higher in the recanalization rate in late thrombolysis when Reteplase group and Alteplase group compared with the UK group(P<0.05),while there was no significantly difference in the recanalization rate in early thrombolysis when Reteplase group and Alteplase group compared with the UK group (P>0.05).4.The degree of heart function and myocardial injury: There was significantly higher in the LVEF values when Reteplase group and Alteplase group compared with the UK group(P<0.05).Furthermore,there was significantly lower in the CTnI and CK-MB peak when Reteplase group and Alteplase group compared with the UK group,and there was significantly difference in the CTnI peak(P<0.05),but there was no significantly difference in CK-MB peak(P>0.05).There was no significantly difference in LVEF value,CK-MB peak and CTnI peak between Alteplase and Reteplase(P>0.05).In addition,there was significantly difference in the time to the CK-MB peak when Reteplase group compared with the UK group and Alteplase group (P<0.05).5.The hospitalization complications: There was significantly difference in the rate of appearing to cardiac aneurysm,heart failure,severe arrhythmia when Reteplase group and Alteplase group compared with the UK group(P<0.05).but there was no difference in them between Alteplase group and Reteplase group(P>0.05).In Other complications,the rate of pericardial effusion, cardiac stock,post-infarction angina,vascular reocclusion,the hospitalization case fatality rate in Alteplase group and Reteplase group were lower than those in UK group,but there was no difference among there groups(P>0.05);There was 2 case(2.86%) patients of cerebral hemorrhage in Reteplase group , but there was no difference in it among there groups(P>0.05).Conclusions:1.Low dose Alteplase and reteplase proved to be much better than UK in the recanalization rate of clinical standard after thrombolytic therapy with AMI, while the recanalization rate of clinical standard by Reteplase are higher than low dose Alteplase ,but there are no significantly difference between two groups.2.There are no significantly difference in the recanalization rate and the hospitalization case fatality rate by UK,Alteplase and Reteplase in early thrombolytic therapy.But there are significantly difference in the recanalization rate by low dose Alteplase and Reteplase in late thrombolytic therapy3.When low dose Alteplase and Reteplase compared with the UK group in thrombolytic therapy,they has led to early, rapid opening of infarct-related artery, to save the dying heart, to reduce infarct areas and myocardial injury ,improve heart function and prognosis. There are no significantly difference in them between low dose Alteplase and Reteplase.
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