title: The efficacy and safety of pharmacoinvasive therapy with prourokinase for acute ST-segment elevation myocardial infarction patients with expected long percutaneous coronary intervention-related delay.
abstract: OBJECTIVE
  To elucidate the efficacy and safety of pharmacoinvasive therapy by using prourokinase (prouk) in patients with ST-segment elevation myocardial infarction (STEMI).
  
  
  BACKGROUND
  Patients with STEMI often have long percutaneous coronary intervention (PCI)-related delays due to various reasons, which are associated with poor outcomes.
  
  
  METHODS
  A randomized study which enrolled patients from four centers in China 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 (MACE, 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 ninety-seven eligible patients were enrolled, of whom 100 were randomized to the prouk-PCI group. Significantly more patients in the prouk-PCI group than in the PCI group had an opened infarct-related artery on arrival in the catheterization laboratory (48% vs. 21%, P = 0.0002) and better TIMI frame count after PCI (33 ± 6 vs. 40 ± 10, 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 (7.0% vs. 12.6%, P = 0.235) or be readmitted to hospital due to new or worsening congestive heart failure (1.0% vs. 4.1%, P = 0.209).
  
  
  CONCLUSIONS
  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 in patients with STEMI and long PCI-related delay.
authors: Department of Cardiology, Shenyang Northern Hospital, Shenyang, Liaoning, China.
authors: Ya-Ling
authors: YL
authors: Han
authors: Jian-Ning
authors: JN
authors: Liu
authors: Quan-Min
authors: QM
authors: Jing
authors: Ying-Yan
authors: YY
authors: Ma
authors: Tie-Min
authors: TM
authors: Jiang
authors: Kui
authors: K
authors: Pu
authors: Rui-Ping
authors: RP
authors: Zhao
authors: Xin
authors: X
authors: Zhao
authors: Hai-Wei
authors: HW
authors: Liu
authors: Kai
authors: K
authors: Xu
authors: Geng
authors: G
authors: Wang
authors: Bin
authors: B
authors: Wang
authors: Rui-Hua
authors: RH
authors: Sun
authors: Jie
authors: J
authors: Wang
mesh_terms: D000208:Acute Disease; D000368:Aged; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D062645:Percutaneous Coronary Intervention; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D013997:Time Factors; D014568:Urokinase-Type Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D014568:Urokinase-Type Plasminogen Activator; C067551:saruplase
keywords: Interventional cardiology; Myocardial infarction; Percutaneous coronary intervention; Pharmacoinvasive therapy; Prourokinase; Thrombolysis