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Journal of Cardiothoracic Surgery
Published in: Journal of Cardiothoracic Surgery 1/2024

Open Access 01-12-2024 | ST-Segment Elevation Myocardial Infarction | Research

Efficacy and safety of intracoronary pro-urokinase combined with low-pressure balloon pre-dilatation during percutaneous coronary intervention in patients with anterior ST-segment elevation myocardial infarction

Authors: Shicheng Yu, Haoxuan Jia, Shengkai Ding, Mengda Zhang, Fengyun Li, Pan Xu, Yuan Tian, Lingling Ma, Lijie Gong, Jun Feng, Zhaojin Sun, Fudong Qian, Hui Li

Published in: Journal of Cardiothoracic Surgery | Issue 1/2024

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Abstract

Background

The efficacy and safety of low-pressure balloon pre-dilatation before intracoronary pro-urokinase (pro-UK) in preventing no-reflow during percutaneous coronary intervention (PCI) remains unknown. This study aimed to evaluate the clinical outcomes of intracoronary pro-UK combined with low-pressure balloon pre-dilatation in patients with anterior ST-segment-elevation myocardial infarction (STEMI).

Methods

This was a randomized, single-blind, investigator-initiated trial that included 179 patients diagnosed with acute anterior STEMI. All patients were eligible for PCI and were randomized into two groups: intracoronary pro-UK combined with (ICPpD group, n = 90) or without (ICP group, n = 89) low-pressure balloon pre-dilatation. The main efficacy endpoint was complete epicardial and myocardial reperfusion. The safety endpoints were major adverse cardiovascular events (MACEs), which were analyzed at 12 months follow-up.

Results

Patients in the ICPpD group presented significantly higher TIMI myocardial perfusion grade 3 (TMPG3) compared to those in the ICP group (77.78% versus 68.54%, P = 0.013), and STR ≥ 70% after PCI 30 min (34.44% versus 26.97%, P = 0.047) or after PCI 90 min (40.0% versus 31.46%, P = 0.044). MACEs occurred in 23 patients (25.56%) in the ICPpD group and in 32 patients (35.96%) in the ICP group. There was no difference in hemorrhagic complications during hospitalization between the groups.

Conclusion

Patients with acute anterior STEMI presented more complete epicardial and myocardial reperfusion with adjunctive low-pressure balloon pre-dilatation before intracoronary pro-UK during PCI.

Trial registration

2019xkj213.
Literature
1.
Wu Y, Benjamin EJ, MacMahon S. Prevention and Control of Cardiovascular Disease in the Rapidly Changing Economy of China. Circulation. 2016;133(24):2545–60.CrossRefPubMedPubMedCentral
2.
Li J, et al. ST-segment elevation myocardial infarction in China from 2001 to 2011 (the China PEACE-Retrospective Acute Myocardial Infarction Study): a retrospective analysis of hospital data. Lancet. 2015;385(9966):441–51.CrossRefPubMed
3.
Ibanez B, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119–77.CrossRefPubMed
4.
Winchester DE, et al. Efficacy and safety of unfractionated heparin plus glycoprotein IIb/IIIa inhibitors during revascularization for an acute coronary syndrome: a meta-analysis of randomized trials performed with stents and thienopyridines. Clin Cardiol. 2012;35(2):93–100.CrossRefPubMed
5.
Ge J, et al. Thrombus Aspiration for ST-Segment-Elevation Myocardial Infarction in Modern Era: Still an Issue of Debate? Circ Cardiovasc Interv. 2017;10(10):e005739.CrossRefPubMed
6.
Bulluck H, et al. Invasive Assessment of the Coronary Microcirculation in Reperfused ST-Segment-Elevation Myocardial Infarction Patients: Where Do We Stand? Circ Cardiovasc Interv. 2017;10(3):e004373.CrossRefPubMed
7.
Henriques JP, et al. Incidence and clinical significance of distal embolization during primary angioplasty for acute myocardial infarction. Eur Heart J. 2002;23(14):1112–7.CrossRefPubMed
8.
Wang X, et al. Rationale and design of the RESTORE trial: A multicenter, randomized, double-blinded, parallel-group, placebo-controlled trial to evaluate the effect of Shenfu injection on myocardial injury in STEMI patients after primary PCI. Am Heart J. 2023;260:9–17.CrossRefPubMed
9.
Okamura A, et al. Detection of embolic particles with the Doppler guide wire during coronary intervention in patients with acute myocardial infarction: efficacy of distal protection device. J Am Coll Cardiol. 2005;45(2):212–5.CrossRefPubMed
10.
Sezer M, et al. Coronary microcirculation in nonculprit vessel territory in reperfused acute myocardial infarction. Microvasc Res. 2023;147: 104495.CrossRefPubMed
11.
Maznyczka A, Haworth PAJ. Adjunctive Intracoronary Fibrinolytic Therapy During Primary Percutaneous Coronary Intervention. Heart Lung Circ. 2021;30(8):1140–50.CrossRefPubMed
12.
Kulick N, Friede KA, Stouffer GA. Safety and efficacy of intracoronary thrombolytic agents during primary percutaneous coronary intervention for STEMI. Expert Rev Cardiovasc Ther. 2023;21(3):165–75.CrossRefPubMed
13.
Mayer K, et al. Efficacy and Safety of Revacept, a Novel Lesion-Directed Competitive Antagonist to Platelet Glycoprotein VI, in Patients Undergoing Elective Percutaneous Coronary Intervention for Stable Ischemic Heart Disease: The Randomized, Double-blind, Placebo-Controlled ISAR-PLASTER Phase 2 Trial. JAMA Cardiol. 2021;6(7):753–61.CrossRefPubMed
14.
Tebbe U, et al. Randomized, double-blind study comparing saruplase with streptokinase therapy in acute myocardial infarction: the COMPASS Equivalence Trial. Comparison Trial of Saruplase and Streptokinase (COMASS) Investigators. J Am Coll Cardiol. 1998;31(3):487–93.CrossRefPubMed
15.
Bär F.W, et al. Comparison of saruplase and alteplase in acute myocardial infarction. SESAM Study Group. The Study in Europe with Saruplase and Alteplase in Myocardial Infarction. Am J Cardiol. 1997;79(6):727–32.CrossRefPubMed
16.
Huang D, et al. Effects of Intracoronary Pro-urokinase or Tirofiban on Coronary Flow During Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction: A Multi-Center, Placebo-Controlled, Single-Blind. Randomized Clinical Trial Front Cardiovasc Med. 2021;8: 710994.CrossRefPubMed
17.
GUSTO investigators. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med. 1993;329(10):673–82.CrossRef
18.
TIMI Study Group. The Thrombolysis in Myocardial Infarction (TIMI) trial. Phase I findings. N Engl J Med. 1985;312(14):932–6.CrossRef
19.
Gibson CM, et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation. 1996;93(5):879–88.CrossRefPubMed
20.
Gibson CM, et al. Relationship of TIMI myocardial perfusion grade to mortality after administration of thrombolytic drugs. Circulation. 2000;101(2):125–30.CrossRefPubMed
21.
Ding S, et al. TIMI myocardial perfusion frame count: a new method to assess myocardial perfusion and its predictive value for short-term prognosis. Catheter Cardiovasc Interv. 2010;75(5):722–32.CrossRefPubMed
22.
Pu J, et al. Factors affecting thrombolysis in myocardial infarction myocardial perfusion frame count: insights of myocardial tissue-level reperfusion from a novel index for assessing myocardial perfusion. Chin Med J (Engl). 2011;124(6):873–8.PubMed
23.
Schröder R, et al. Extent of early ST segment elevation resolution: a simple but strong predictor of outcome in patients with acute myocardial infarction. J Am Coll Cardiol. 1994;24(2):384–91.CrossRefPubMed
24.
Greco C, et al. Usefulness of local delivery of thrombolytics before thrombectomy in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (the delivery of thrombolytics before thrombectomy in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention [DISSOLUTION] randomized trial). Am J Cardiol. 2013;112(5):630–5.CrossRefPubMed
25.
Jiang W, et al. Safety and efficacy study of prourokinase injection during primary percutaneous coronary intervention in acute ST-segment elevation myocardial infarction. Coron Artery Dis. 2021;32(1):25–30.CrossRefPubMed
26.
Yin XS, et al. Efficacy and safety of intracoronary pro-urokinase injection during percutaneous coronary intervention in treating ST elevation myocardial infarction patients: a systematic review and meta-analysis of randomized controlled trials. Eur Rev Med Pharmacol Sci. 2022;26(16):5802–13.PubMed
27.
Pu J, et al. Efficacy and Safety of a Pharmaco-Invasive Strategy With Half-Dose Alteplase Versus Primary Angioplasty in ST-Segment-Elevation Myocardial Infarction: EARLY-MYO Trial (Early Routine Catheterization After Alteplase Fibrinolysis Versus Primary PCI in Acute ST-Segment-Elevation Myocardial Infarction). Circulation. 2017;136(16):1462–73.CrossRefPubMed
28.
McCartney PJ, et al. Effect of Low-Dose Intracoronary Alteplase During Primary Percutaneous Coronary Intervention on Microvascular Obstruction in Patients With Acute Myocardial Infarction: A Randomized Clinical Trial. JAMA. 2019;321(1):56–68.CrossRefPubMedPubMedCentral
29.
Heusch G, et al. Cardiovascular remodelling in coronary artery disease and heart failure. Lancet. 2014;383(9932):1933–43.CrossRefPubMed
30.
31.
Krug A, de Du Mesnil R, Korb G. Blood supply of the myocardium after temporary coronary occlusion. Circ Res. 1966;19(1):57–62.CrossRefPubMed
32.
Ito H. No-reflow phenomenon and prognosis in patients with acute myocardial infarction. Nat Clin Pract Cardiovasc Med. 2006;3(9):499–506.CrossRefPubMed
33.
Heusch G, et al. Coronary microembolization: from bedside to bench and back to bedside. Circulation. 2009;120(18):1822–36.CrossRefPubMed
34.
Kleinbongard P, et al. Vasoconstrictor potential of coronary aspirate from patients undergoing stenting of saphenous vein aortocoronary bypass grafts and its pharmacological attenuation. Circ Res. 2011;108(3):344–52.CrossRefPubMed
35.
Kwan TW, et al. Epidemiology of Diabetes and Atherosclerotic Cardiovascular Disease Among Asian American Adults: Implications, Management, and Future Directions: A Scientific Statement From the American Heart Association. Circulation. 2023;148(1):74–94.CrossRefPubMed
36.
Boswell-Patterson CA, et al. Novel theranostic approaches to neovascularized atherosclerotic plaques. Atherosclerosis. 2023;374:1–10.CrossRefPubMed
37.
Lee JM, et al. Safety and Efficacy of Everolimus-Eluting Bioresorbable Vascular Scaffold Versus Second-Generation Drug-Eluting Stents in Real-World Practice. J Korean Med Sci. 2023;38(5): e34.CrossRefPubMedPubMedCentral
38.
Granada JF, et al. First clinical evaluation of a luminal self-expanding shield in patients with intermediate coronary lesions. EuroIntervention. 2011;7(7):780–8.CrossRefPubMed
39.
Sezer M, et al. Gradual Versus Abrupt Reperfusion During Primary Percutaneous Coronary Interventions in ST-Segment-Elevation Myocardial Infarction (GUARD). J Am Heart Assoc. 2022;11(10): e024172.CrossRefPubMedPubMedCentral
Metadata
Title
Efficacy and safety of intracoronary pro-urokinase combined with low-pressure balloon pre-dilatation during percutaneous coronary intervention in patients with anterior ST-segment elevation myocardial infarction
Authors
Shicheng Yu
Haoxuan Jia
Shengkai Ding
Mengda Zhang
Fengyun Li
Pan Xu
Yuan Tian
Lingling Ma
Lijie Gong
Jun Feng
Zhaojin Sun
Fudong Qian
Hui Li
Publication date
01-12-2024
Publisher
BioMed Central
Published in
Journal of Cardiothoracic Surgery / Issue 1/2024
Electronic ISSN: 1749-8090
DOI
https://doi.org/10.1186/s13019-024-02699-7

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