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Long-term outcome of patients with ST-segment elevation myocardial infarction treated with low-dose intracoronary thrombolysis during primary percutaneous coronary intervention: the 5-year results of the DISSOLUTION Trial

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Abstract

We tested the hypothesis that adjunctive thrombolysis at time of primary percutaneous coronary intervention (PCI) may affect favourably the long-term outcome of patients with ST elevation myocardial infarction (STEMI). To this end, we undertook a substudy of the DISSOLUTION (Delivery of thrombolytIcs before thrombectomy in patientS with ST-segment elevatiOn myocardiaL infarction Undergoing primary percuTaneous coronary interventION) trial. A total of 95 patients were randomized to local delivery of urokinase (n = 48) or placebo (n = 47). After PCI, a greater proportion of patients receiving urokinase had an improvement in myocardial perfusion, as indicated by a significantly higher final Thrombolysis in myocardial infarction (TIMI) grade 3, myocardial blush grade, and 60-min ST-segment resolution > 70%, as well as lower corrected TIMI frame count. At 1-year echocardiography, urokinase-treated patients exhibited significantly lower LV dimension, as well as higher LV ejection fraction and wall motion score index as compared with placebo-treated patients. At 5 years, major acute cardiovascular events (MACEs) were significantly less common in the urokinase group (P = 0.023), mainly due to a lower occurrence of hospitalisation for heart failure (P = 0.038). Multivariate analysis showed that factors independently associated with 5-year occurrence of MACEs were LV remodelling at 1-year echocardiography (P = 0.0001), 1-year LV ejection fraction (P = 0.0001), TIMI grade flow 0–2 (P = 0.0019), and age at time of PCI (P = 0.0173). In conclusion, low-dose intracoronary urokinase during primary PCI is associated with a more favourable 5-year outcome of patients with STEMI.

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Authors and Affiliations

  1. Department of Cardiovascular Sciences, Sapienza University, Rome, Italy

    Francesco Pelliccia, Cesare Greco, Gaetano Tanzilli, Nicola Viceconte, Michele Schiariti & Carlo Gaudio

  2. Department ‘Attilio Reale’, Sapienza University, Via del Policlinico 155, 00161, Rome, Italy

    Francesco Pelliccia

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  1. Francesco Pelliccia
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  2. Cesare Greco
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  3. Gaetano Tanzilli
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  4. Nicola Viceconte
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  5. Michele Schiariti
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  6. Carlo Gaudio
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Correspondence to Francesco Pelliccia.

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Pelliccia, F., Greco, C., Tanzilli, G. et al. Long-term outcome of patients with ST-segment elevation myocardial infarction treated with low-dose intracoronary thrombolysis during primary percutaneous coronary intervention: the 5-year results of the DISSOLUTION Trial. J Thromb Thrombolysis 51, 212–216 (2021). https://doi.org/10.1007/s11239-020-02157-w

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