Pelliccia Francesco, Greco Cesare, Tanzilli Gaetano, Viceconte Nicola, Schiariti Michele, Gaudio Carlo
Department of Cardiovascular Sciences, Sapienza University, Rome, Italy.
Department 'Attilio Reale', Sapienza University, Via del Policlinico 155, 00161, Rome, Italy.
J Thromb Thrombolysis. 2021 Jan;51(1):212-216. doi: 10.1007/s11239-020-02157-w.
We tested the hypothesis that adjunctive thrombolysis at time of primary percutaneous coronary intervention (PCI) may affect favourably the long-term outcome of patients with ST elevation myocardial infarction (STEMI). To this end, we undertook a substudy of the DISSOLUTION (Delivery of thrombolytIcs before thrombectomy in patientS with ST-segment elevatiOn myocardiaL infarction Undergoing primary percuTaneous coronary interventION) trial. A total of 95 patients were randomized to local delivery of urokinase (n = 48) or placebo (n = 47). After PCI, a greater proportion of patients receiving urokinase had an improvement in myocardial perfusion, as indicated by a significantly higher final Thrombolysis in myocardial infarction (TIMI) grade 3, myocardial blush grade, and 60-min ST-segment resolution > 70%, as well as lower corrected TIMI frame count. At 1-year echocardiography, urokinase-treated patients exhibited significantly lower LV dimension, as well as higher LV ejection fraction and wall motion score index as compared with placebo-treated patients. At 5 years, major acute cardiovascular events (MACEs) were significantly less common in the urokinase group (P = 0.023), mainly due to a lower occurrence of hospitalisation for heart failure (P = 0.038). Multivariate analysis showed that factors independently associated with 5-year occurrence of MACEs were LV remodelling at 1-year echocardiography (P = 0.0001), 1-year LV ejection fraction (P = 0.0001), TIMI grade flow 0-2 (P = 0.0019), and age at time of PCI (P = 0.0173). In conclusion, low-dose intracoronary urokinase during primary PCI is associated with a more favourable 5-year outcome of patients with STEMI.
在直接经皮冠状动脉介入治疗（PCI）时进行辅助溶栓可能会对ST段抬高型心肌梗死（STEMI）患者的长期预后产生有利影响。为此，我们对溶栓治疗（在接受直接经皮冠状动脉介入治疗的ST段抬高型心肌梗死患者中，血栓切除术前行溶栓治疗）试验进行了一项子研究。总共95例患者被随机分为局部注射尿激酶组（n = 48）或安慰剂组（n = 47）。PCI术后，接受尿激酶治疗的患者中有更大比例的心肌灌注得到改善，这表现为心肌梗死溶栓治疗（TIMI）最终3级、心肌显影分级显著更高，60分钟ST段回落>70%，以及校正TIMI帧数更低。在1年超声心动图检查时，与接受安慰剂治疗的患者相比，接受尿激酶治疗的患者左心室尺寸显著更小，左心室射血分数和室壁运动评分指数更高。在5年时，尿激酶组的主要急性心血管事件（MACE）明显较少见（P = 0.023），主要原因是因心力衰竭住院的发生率较低（P = 0.038）。多变量分析显示，与5年MACE发生独立相关的因素为1年超声心动图检查时的左心室重构（P = 0.0001）、1年左心室射血分数（P = 0.0001）、TIMI血流分级0 - 2级（P = 0.0019）以及PCI时的年龄（P = 0.0173）。总之，直接PCI期间低剂量冠状动脉内尿激酶治疗与STEMI患者更有利的5年预后相关。
