Department of Immunology, Department of Neurosurgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan, People's Republic of China.
Eur Rev Med Pharmacol Sci. 2022 Aug;26(16):5802-5813. doi: 10.26355/eurrev_202208_29518.
Intracoronary injection of pro-urokinase (Pro-UK) during percutaneous coronary intervention (PCI) seems to be a promising treatment in improving myocardial perfusion. In this systematic review and meta-analysis, we aimed at investigating the efficacy and safety of intracoronary Pro-UK injection during PCI in ST elevation myocardial infarction (STEMI) patients.
A comprehensive literature searched on PubMed, Embase, Cochrane, Ovid-MEDLINE, Ovid-Embase, Ovid-Cochrane Databases and ClinicalTrials.gov from inception until June 1, 2022, in English only. The primary outcome was myocardial perfusion, including thrombolysis in myocardial infarction (TIMI) grades, corrected TIMI frame count (CTFC), TIMI myocardial perfusion grades (TMPG). The secondary outcomes were ST-segment resolution (STR), major adverse cardiovascular events (MACE), myocardial marker, cardiac function and hemorrhagic complications.
We identified 5 studies (all RCTs) involving 761 participants. Under PCI procedure, compared with placebo, intracoronary Pro-UK injection may improve myocardial perfusion, including increasing the TIMI grades [odd ratio (OR) 0.46; 95% confidence interval (CI) 0.28-0.75; p = 0.002; I2 = 0%] , CTFC (OR -3.47; 95% CI [-5.60, -1.33]; p = 0.001; I2 = 0%) and TMPG (OR 0.17; 95% CI [0.06-0.44]; p = 0.0003; I2 = 0%), increase the rate of STR (OR 2.25; 95% CI [1.56-3.26]; p < 0.0001; I2 = 0%), reduce the incidence of MACE (OR 0.51; 95% CI [0.33-0.81]; p = 0.004; I2 = 0%) and reduce myocardial infarct size (CK, standardized mean difference [SMD] -0.45; 95% [CI] [-0.62, -0.28]; p < 0.00001; I2 = 10%. CK-MB, [SMD] -0.43; 95% CI [-0.68, -0.18]; p = 0.0007; I2 = 60%. cTnI, [SMD] -0.31; 95% CI [-0.46, -0.17]; p < 0.0001; I2 = 0%). Moreover, the treatment may improve the cardiac functions (LVFE, pooled mean difference [MD] 1.23; 95% CI [0.66-1.79]; p < 0.0001; I2 = 24%. LVEDd, pooled MD -0.13; 95% CI [-0.17, -0.09]; p < 0.00001; I2 = 0%). But there is no statistically significant difference between the Pro-UK group and placebo in the occurrence of hemorrhagic complications (OR 1.19; 95% CI [0.75-1.87]; p = 0.46; I2 = 0%).
Intracoronary Pro-UK injection during PCI in STEMI patients is an effective and safe treatment to perform. The treatment may improve myocardial perfusion and rate of STR, as well as decreasing the incidence of MACE and myocardial infarct size. Importantly, the treatment may improve the cardiac functions and life quality. In the future, more multi-centered and massive sample studies are required.
经皮冠状动脉介入治疗（PCI）期间冠状动脉内注射前尿激酶（Pro-UK）似乎是改善心肌灌注的一种很有前景的治疗方法。在这项系统评价和荟萃分析中，我们旨在研究急性 ST 段抬高型心肌梗死（STEMI）患者 PCI 期间冠状动脉内注射 Pro-UK 的疗效和安全性。
我们仅以英文在 PubMed、Embase、Cochrane、Ovid-MEDLINE、Ovid-Embase、Ovid-Cochrane 数据库和 ClinicalTrials.gov 上进行了全面的文献检索，检索时间从创建至 2022 年 6 月 1 日。主要结局是心肌灌注，包括心肌梗死溶栓治疗（TIMI）分级、校正 TIMI 帧数（CTFC）、TIMI 心肌灌注分级（TMPG）。次要结局是 ST 段回落（STR）、主要不良心血管事件（MACE）、心肌标志物、心功能和出血并发症。
我们确定了 5 项研究（均为 RCT），共纳入 761 名参与者。在 PCI 过程中，与安慰剂相比，冠状动脉内注射 Pro-UK 可能改善心肌灌注，包括增加 TIMI 分级[比值比（OR）0.46；95%置信区间（CI）0.28-0.75；p=0.002；I2=0%]、CTFC（OR-3.47；95%CI [-5.60，-1.33]；p=0.001；I2=0%）和 TMPG（OR 0.17；95%CI [0.06-0.44]；p=0.0003；I2=0%），提高 STR 率（OR 2.25；95%CI [1.56-3.26]；p<0.0001；I2=0%），降低 MACE 发生率（OR 0.51；95%CI [0.33-0.81]；p=0.004；I2=0%）和心肌梗死面积（CK，标准化均数差值[SMD]-0.45；95%CI [-0.62，-0.28]；p<0.00001；I2=10%。CK-MB，[SMD]-0.43；95%CI [-0.68，-0.18]；p=0.0007；I2=60%。cTnI，[SMD]-0.31；95%CI [-0.46，-0.17]；p<0.0001；I2=0%）。此外，该治疗可能改善心功能（LVFE，合并均数差[MD]1.23；95%CI [0.66-1.79]；p<0.0001；I2=24%。LVEDd，合并 MD-0.13；95%CI [-0.17，-0.09]；p<0.00001；I2=0%）。但是，Pro-UK 组和安慰剂组在出血并发症的发生方面没有统计学显著差异（OR 1.19；95%CI [0.75-1.87]；p=0.46；I2=0%）。
在 STEMI 患者中，PCI 期间冠状动脉内注射 Pro-UK 是一种有效且安全的治疗方法。该治疗可能改善心肌灌注和 STR 率，并降低 MACE 和心肌梗死面积的发生率。重要的是，该治疗可能改善心功能和生活质量。未来需要更多的多中心、大样本研究。
