Effect Of Supra Selective Intracoronary Thrombolysis In Patiencts With Rescue Percutaneous Coronary Intervention

Objective To investigate therapeutic efficacy and safety of superselective intracoronary application of recombinant human pro-urokinase in patients with rescue percutaneous coronary intervention.Methods 90 patients who rescue PCI at Tangshan Gongren Hospital from September2016 to January 2019 were selected as subjectors.The patients were divided into the prourokinase group(46 cases)and the control group(44 cases).In the pro-urokinase group,thrombus aspiration was operated on the coronary lesion by aspiration catheter,and then recombinant human pro-urokinase was injected into the distal end of the lesion.In the control group,thrombus aspiration was operated on the lesion by aspiration catheter during operation.Baseline clinical data between two groups were collected and compared,and thrombolysis in myocardial infarction(TIMI)thrombolysis score,corrected TIMI frame count(CTFC),myocardial blush grade(MBG),the electrocardiogram of postoperative 2hours,CK-MB peaks and cTNI peaks,the fibrinogen of preoperative and 2 hours,24 hours after operation,the echocardiography of preoperative and postoperative 30 days,and major adverse cardiovascular event(MACE)and bleeding events were recordrd during hospitalization and follow-up period.Results 1 There were no significant differences between the pro-urokinase group and the control group in terms of age,gender,risk factors,infarction related artery and other baseline clnical data(P>0.05);2 The percent of postoperative TIMI flow grade 3,there was no significant difference between the pro-urokinase group and the control group(P>0.05);the percent of the ST-segment regression of 2 hours after operation(73.9% vs52.3%)was higher in the pro-urokinase group than that in the control group.The prourokinase group was compared with the control group,the number of CTFC frames were(26.30±3.64)frames and(28.27±4.15)frames,respectively.The number of MBG grade 3(87.0% vs 68.2%)was more in the pro-urokinase group than that in the control group,there were significant differences between the pro-urokinase group and the control group(P<0.05).3 No statistical difference were observed in term of CK-MB peaks and cTNI peaks between the pro-urokinase group and the control group.There was no statistical significance to compare fibrinogen between the two groups before operation and 2h,24 h after operation(P>0.05).4 The left ventricular ejection fraction(LVEF)of postoperative30 days(55.93 ±8.00 % vs 51.98±7.94 %,P=0.022)was higher in the pro-urokinase group than that in the control group.The left ventricular end diastolic diameter(LVEDD)of postoperative 30 days(47.25±3.60 mm vs 48.77±3.33 mm,P=0.043)was lower in the pro-urokinase group than that in the control group,there was significant difference in LVEF and LVEDD between the pro-urokinase group and the control group at 30 days postoperative.There was also significant difference between LVEF and LVEDD in preoperative and postoperative(P<0.05).5 There was no significant difference in the incidence of MACE and bleeding events between the pro-urokinase group and the control group during the hospitalization and the 30 days follow-up period(P>0.05).Conclusion Superselective intracoronary injected the recombinant human pro-urokinase during rescue PCI can further increase the level of myocardial perfusion and improve the function of left ventricular ejection,and does not increase the risk of bleeding.Figure0;Table8;Reference 154.