Effects of intracoronary low-dose urokinase injection combined with stent implantation in acute STEMI patients on myocardial perfusion and its influence on short-term prognosis

Objective　To investigate the effects of primary percutaneous coronary intervention (PCI) combined with intracoronary low-dose urokinase therapy on myocardial perfusion and clinical outcome in acute STEMI patients. Methods　From Oct. 2011 to Jun. 2013, 183 patients suffering from myocardial infarction with acute ST segment elevation, (STEMI) who had undergone emergent PCI in 306 Hospital of PLA conforming to inclusion criteria were enrolled in the present study. They were randomly assigned to urokinase group (n=91) and control group (n=92). For urokinase group, besides routine interventional treatment, patients were given single or multiple intracoronary injection of 0.05-0.1 million U urokinase immediately before primary PCI, while for control group, patients received routine interventional treatment only. The main indices determined and compared between the two groups included the immediate blood flow grading of thrombolysis in myocardial infarction (TIMI), corrected TIMI frame count, falling degree of ST segment elevation in ECG after intervention, and left ventricular function on the 7th and 30th day after intervention, and also major adverse cardiac events (MACE) on the 30th day after intervention. Results　The TIMI Ⅲ blood flow and corrected TIMI frame count were obviously better in urokinase group than in control group (83 vs71, P=0.034; 21.2±10.7 vs29.6±15.3, P=0.012) immediately after PCI, ant the falling degree >70% of ST segment elevation at 90min after intervention was significantly more marked in urokinase group than that in control group (93.4% vs82.6%, P=0.025). When compared with urokinase group to control group, although no significant difference was found in left ventricular ejection fraction (LVEF) on the 7th day of follow-up (53.5±9.4 vs51.6±8.7, P=0.158), the cardiac ultrasound revealed a better outcome of LVEF (56.3±9.8 vs53.5±8.1, P=0.036) and a lower MACEs (including death, angina, target vessel revascularization, heart failure and stroke, etc.)(4.4% vs13.0%, P=0.038) on the 30th day of follow-up. Conclusion　Emergency PCI combined with single or multiple intracoronary injection of low-dose urokinase before stent implantation may efficiently improve the myocardial perfusion and left ventricular function, and improve the short-term prognosis of acute myocardial infarction patients with due safety. DOI: 10.11855/j.issn.0577-7402.2015.08.12