冠状动脉内应用尿激酶原溶栓联合PPCI对STEMI患者的即刻及长期疗效

Transient and long term efficacy of intracoronary recombinant human prourokinase administered on STEMI patients with primary PCI

目的探讨冠状动脉内尿激酶原溶栓联合直接经皮冠状动脉介入治疗(PPCI)对急性ST段抬高性心肌梗死(STEMI)的即刻及长期疗效。方法采用前瞻、随机、对照的方法纳入符合条件的STEMI患者,分为观察组(尿激酶原溶栓+PPCI组)及对照组(常规PPCI组)。观察的一级终点包括心肌梗死溶栓治疗临床试验(TIMI)血流分级、TIMI计数、心肌充血分级等,次级终点包括全因病死率、再梗死率、血管重构以及恶化心衰导致的再住院率。结果符合条件的117例患者入选此项研究,观察组59例,对照组58例。治疗后,观察组与对照组比较,TIMI血流分级升高(P=0.002),而校正的TIMI血流帧数计数(cTFC)显著降低(32±7vs.41±12,P<0.001)。30d及1年随访,观察组与对照组两者之间因新发或加重心衰再住院率比较差异有统计学意义(1.69%vs.8.62%,5.09%vs.13.79%;P=0.0138,0.0361)。而30d及1年随访的出血事件均无统计学意义(P>0.05)。结论联合应用尿激酶原冠状动脉内溶栓治疗STEMI较单纯PPCI治疗可进一步改善患者的心肌灌注水平,且不增加住院期间出血事件的发生率。

Objective Patients with ST-segment elevation myocardial infarction(STEMI)who were given PCI often have myocardial reperfusion injury,which is associated with poor outcomes.This study aims to elucidate the efficacy and safety of pharmacoinvasive therapy by using prourokinase(prouk)in patients with STEMI.Methods A randomized study which enrolled patients from Xinxiang Central Hospital was conducted.Patients were randomly assigned to accept routine primary PCI or prouk-PCI.The primary end points were the angiographic parameters,including thrombolysis in myocardial infarction(TIMI)flow grade,TIMI frame count,and myocardial blush grade.Secondary endpoints were incidence of major adverse cardiac events(MACCE,defined as death from all causes,reinfarction,revascularization,or rehospitalization due to new or worsening congestive heart failure)at 30 days and 1 year.Results One hundred and seventeen eligible patients were enrolled,of whom 59 were randomized to the prouk-PCI group.Significantly more patients in the prouk-PCI group than in the PCI group had better TIMI frame count after PCI(32 ± 7 vs.41 ± 12,P<0.001).At 1-year follow-up,there was a trend that patients in the prouk-PCI group had less chances to have MACE(1.69% vs.8.62%,P=0.0138)or be readmitted to hospital due to new or worsening congestive heart failure(5.09% vs.13.79%,P=0.0361).Conclusion A strategy of emergent PCI preceded by fibrinolysis with prouk results in a better myocardial perfusion in infarct-related artery compared with primary PCI alone.