Efficacy Of Different Intracoronary Administration Methods Of Prourokinase In Patients With Acute ST-segment Elevation Myocardial Infarction

Objectives:To compare the effects of two prourokinase administration methods on myocardial perfusion and short-term prognosis after percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction(STEMI),and the two modes of administration refer to one-time intracoronary prourokinase injection and fractional intracoronary prourokinase injection in PCI.Methods:Patients who were diagnosed with STEMI for the first time and going to receive emergency PCI from August 2016 to October 2017 in the cardiovascular department of the Third Hospital of Hebei Medical University were enrolled,and after excluding the circumstances of cardiogenic shock,previous coronary artery bypass grafting,severe coagulation disorders or contraindications,the final 102 patients were selected in this study.All patients were randomly divided into two groups according to random number table method:forty nine patients in group A received three doses of intracoronary recombinant human prourokinase injection after guide-wire crossing(4ml),balloon dilation(3ml)and stenting(3ml),a total of 20 mg,other fifty three patients in group B received one dose(10ml)of intracoronary recombinant human prourokinase injection only after guide-wire crossing,also20 mg.Thrombolysis in myocardial infarction(TIMI)flow classification?TIMI myocardial perfusion grading(TMPG)?ST-segment resolution(STR)at 90 minutes after operation and left ventricular ejection fraction(LVEF)one day and 7 days after operation were all used to evaluate myocardial perfusion.Bleeding events within 7 days and major adverse cardiac events(MACE)within 3 months after operation were also compared.Results:1 There were no significant differences between the two groups in terms of age,sex,risk factors,medication,lesion artery,stents,the first medical contact time and the first medical contact to guide-wire crossing time(P>0.05).2 There were no significant differences in TIMI flow classification and TMPG before PCI and the LVEF one day after PCI.between the two groups(P>0.05).After PCI in infarct-related artery(IRA),the TIMI flow classification(P=0.038)and TMPG(P =0.015)improved more significantly in group A compared with group B,and the STR in 90 minutes after operation in group A was obviously better than that in group B(P=0.032).7 days After operation,the LVEF in group A was also significantly higher than that in group B(P = 0.001).3 There was no statistical differences in the incidence of hemorrhage 7days after operation and the incidence of MACE within 3 months after operation between the two groups(P>0.05).Conclusions:For patients with acute STEMI who underwent PCI,the administration of recombinant human urokinase in multiple times could better improve the myocardial perfusion without increasing the incidence of hemorrhage and MACE compared with the administration in only one time,and ultimately improved the prognosis.