The Impact And Safety Of Intracoronary Prourokinase Or Tirofiban Injection On Myocardial Microcirculation Reperfusion In Patients With Acute ST Segment Elevation Myocardial Infarction Before Primary Percutaneous Coronary Intervention

Objective : To investigate the impact and safety of intracoronary Prourokinase or tirofiban injection on myocardial microcirculation reperfusion in patients with acute ST segment elevation myocardial infarction(STEMI)and high thrombotic load before primary percutaneous coronary intervention(PCI).Methods:A total of 30 STEMI patients who visited the chest pain center of the second hospital of hebei medical university from May 2017 to February 2019 and were treated within 12 hours after onset were randomly divided into the prourokinase group(n=15)and the tirofiban group(n=15).Coronary angiography(CAG)was performed in selected patients,and thrombus load score(? 4 points)was assessed according to the results of coronary angiography.Emergency stent placement was performed in patients with fixed stenosis of infarct-related artery(?75%).Before PCI,6 F guide catheter placed in ostium criminal coronary,the guide wire through after the lesion site 1mg of tirofiban+3000U of heparin were injected into the coronary artery for tirofiban group,and 20 mg of prourokinase were injected into the coronary artery for the prourokinase group.Preoperatively,patients in both groups were intravenously treated with anticoagulant therapy such as heparin.The general baseline data of age,sex,heart rate,blood pressure,preoperative electrocardiogram,high risk factors of coronary heart disease and related medical history were collected.Infarction related artery(IRA)and infarction location were determined according to the results of angiography and electrocardiogram.Preoperative and postoperative thromboembolism score and TIMI(Thrombolysis in myocardial infarction)blood flow were compared,and the blood flow velocity of the two groups was compared with the corrected TIMI blood flow frame count(CTFC).The peak value of myocardial injury markers,the number and length of stent implantation,ST segment drop at 2 hours after operation,thrombus catheter aspiration,echocardiography at 1 day and 1 month after operation were compared between the two groups.Left ventricular ejection fraction(LVEF)and left ventricular end-diastolic dimension(LVEDD)were recorded as cardiac function indexes.Standard,bleeding during hospitalization and major adverse cardiac events(MACE).All data were processed by SPSS23.0 statistical software,and the difference was statistically significant according to P < 0.05.Results: A total of 30 patients were included in the study.Among them,prourokinase group set 15(12 cases in men and 3 women),the average age(56.60 ±2.82),tirofiban group set 15(10 cases in men and 5 women),the average age(61.20± 2.87),two groups of patients with baseline data count no statistical difference(P > 0.05).There was no significant difference in the number and length of stent implantation,thrombus aspiration,infarct related artery and infarct location between the two groups(P>0.05).There was no significant difference in preoperative TIMI blood flow grading and thrombus load score between the prourokinase group and tirofiban group(P>0.05).The postoperative TIMI3 blood flow in the prourokinase group was significantly higher than that in the tirofiban group(P<0.05).Compared with the tirofiban group,the blood flow in the prourokinase group was faster(P<0.05)than that in the CTFC group.The scores of thrombus integral compared the postoperative tirofiban group with prourokinase group,There was a downward trend in both groups.However,the thromboembolic score in the prourokinase group was lower than that in tirofiban group,and there was statistical significance(P<0.05).Two groups of patients 1 days after operation cardiac function index,prourokinase group LVEF higher,LVEDD value is low(P=0.012).1 months later,the LVEF and LVEDD values of the prourokinase group and tirofiban group were not significantly different(P>0.05).In the prourokinase group,the 2h ECG ST segment fall rate was higher after PCI(P=0.028).The peak values of Creatinine kinase(CK),creatine kinase is oenzyme MB(CK-MB)and troponin I(Cardiac Tropnin Cardiac)were selected after admitted to hospital.The peak values of CK,CK-MB and cTnI in the prourokinase group and the tirofiban group were lower than those in the prourokinase group(P=0.036).During the hospitalization period,1 cases of ventricular fibrillation and 3 cases of mild bleeding occurred in the prourokinase group.1 cases of stent thrombosis and 2 cases of mild bleeding occurred in tirofiban group.There was no significant difference in the incidence of bleeding events and major adverse events between the two groups(P>0.05).Conclusion:Before PCI for STEMI patients with high thrombotic load by direct percutaneous coronary intervention,intravascular prourokinase therapy has better effects in improving myocardial microcirculation reperfusion,reducing myocardial injury and improving short-term cardiac function,and does not increase the incidence of bleeding and major adverse MACE events,compared with intravascular tirofiban hydrochloride.