Effect of intracoronary injection of recombinant human prourokinase thrombolysis combined with percutaneous coronary intervention on coronary blood flow，no-reflow incidence and prognosis in patients with acute myocardial infarction

Abstract:

Objective：To analyze the effect of intracoronary injection of recombinant human prourokinase thrombolysis combined with percutaneous coronary intervention（PCI） on coronary blood flow，no-reflow incidence and prognosis in patients with acute myocardial infarction（AMI）. Methods：A total of 139 patients with AMI who underwent emergency PCI in Nanyang Central Hospital from Decem－ber 2017 to June 2018 were divided into the thrombolysis group（n=78） and the thrombus aspiration group（n=61） according to the reperfusion method. Recombinant human prourokinase was conversely injected into the target vascular lesion in the thrombolysis group，while the thrombus aspiration was performed in the thrombus aspiration group. Thrombolysis in myocardial infarction（TIMI） blood flow grading and TIMI myocardial perfusion grading before and after surgery，corrected TIMI frame count（CTFC） after surgery and cardiac function changes were compared between two groups. The no-reflow incidence after PCI，ST-segment resolution rate within 90 min，and the incidence of short-term and long-term adverse bleeding and cardiovascular events were statistically analyzed. Influencing factors of no-reflow after PCI in patients with AMI were summarized. Results：There was no significant difference in TIMI blood flow grading between two groups after surgery（P>0.05）. The no-reflow rate in the thrombolysis group was lower than that in the thrombus aspiration group（5.13% vs. 16.39%）（P<0.05）. CTFC in the thrombolysis group was lower than that in the thrombus aspiration group（P<0.05），and the ST-segment resolution rate was higher than that of the thrombus aspira－tion group（94.87% vs. 78.69%）（P<0.05）. Cardiac function indexes in the thrombolysis group at the 30th day after surgery were better than those in the thrombus aspiration group（P<0.05）. There was no significant difference in the incidence of bleeding events or major cardiovascular adverse events between two groups at the post-operative 30th day and during 1 year of follow-up（P>0.05）. The time from onset to admission and myocardial ischemia time were risk factors for no-reflow after PCI in AMI（P<0.05）. Intraoperative thrombolysis was the protective factor. Conclusion：Intracoronary injection of recombinant human prourokinase combined with PCI can improve the perfusion of patients with AMI，reduce the incidence of no-reflow，and may improve the prognosis. The time from onset to admission and myocardial ischemia time are risk factors for no-reflow after PCI in AMI，while intraoperative thrombolysis is a protec－tive factor.