Comparative study on early PCI and delayed PCI in treatment of acute ST-segment elevation myocardial infarction after thrombolysis with recombinant human prourokinase for injection

Wang Xiaoyu; Fan Xizhen; Wang Zhe; Yue Cuitao

doi:10.3969/j.issn.1674-7151.2024.04.007

Abstract：Objective To compare the safety and efficacy of early percutaneous coronary intervention(PCI)and delayed PCI after thrombolysis in patients with acute ST-segment elevation myocardial infarction(STEMI)by giving recombinant human prourokinase(rhPro-uk)for injection.Methods A total of 146 patients with STEMI in multiple medical centers in Anhui Province from December 2020 to December 2023 were selected as study subjects,and rhPro-uk for injection was given for thrombolysis.The 88 patients who underwent PCI treatment within 24 hours after thrombolysis were selected as research group,and 58 patients who underwent PCI treatment after 24 hours were selected as control group.The proportions of ST segment regression>50%,complete relief of chest pain and PCI stent implantation were compared between the two groups,as well as cardiac color ultrasound indicators[left atrial diameter(LAD),left ventricular end-diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF)]before and after 1 month of discharge between two groups were compared.The incidences of all bleeding events in hospital,major adverse cardiovascular events(MACCE)and net clinical adverse events(NACE)were recorded and analyzed.Results The proportion of complete relief of chest pain in research group was higher than that in control group(80.7%vs.51.7%,P<0.05),the proportion of PCI stent implantation in research group was lower than that in control group(64.8%vs.98.3%,P<0.05),and the proportion of ST segment regression>50%was not significantly different between two groups(87.5%vs.86.2%,P>0.05).The level of LVEF before discharge in research group was significantly higher than that in control group[54.50%(44.00%,55.50%)vs.52.50%(42.00%,55.00%),P<0.05].There was no significant difference in LAD and LVEDD between two groups before discharge.One month after discharge,the LAD and LVEDD in research group were lower than those in control group,and LVEF was higher than that of control group[LAD(mm):37.45(35.00,39.45)vs.38.80(36.75,41.00);LVEDD(mm):46.55(43.25,52.85)vs.51.00(46.15,55.50);LVEF:56.00%(53.00%,59.75%)vs.50.50%(46.00%,55.50%);all P<0.05].There were no sudden cardiac death or recurrent myocardial infarction events in both groups in the hospital.There was no statistically significant difference in the incidence of bleeding between two groups.The incidences of MACCE,NACE,congestive heart failure and severe arrhythmia in research group were lower than those in control group(MACCE:9.1%vs.24.1%;NACE:9.1%vs.27.6%;congestive heart failure:3.4%vs.13.8%;severe arrhythmia:3.4%vs.13.8%;all P<0.05).Conclusions PCI treatment within 24 hours after thrombolysis by rhPro-uk for injection in patients with STEMI could significantly improve myocardial remodeling,reduce the number of stents implanted,lower the incidence of adverse events,without significant increase of risk of bleeding.The combination of thrombolysis by rhPro-uk for injection and early PCI treatment for patients with STEMI has better efficacy and higher safety than delayed PCI treatment.