AUTHOR=Huang Dong , Qian Juying , Liu Zongjun , Xu Yawei , Zhao Xianxian , Qiao Zengyong , Fang Weiyi , Jiang Li , Hu Wei , Shen Chengxing , Liang Chun , Zhang Qi , Ge Junbo 

TITLE=Effects of Intracoronary Pro-urokinase or Tirofiban on Coronary Flow During Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction: A Multi-Center, Placebo-Controlled, Single-Blind, Randomized Clinical Trial

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.710994

DOI=10.3389/fcvm.2021.710994

ISSN=2297-055X

ABSTRACT=<p><bold>Background:</bold> To determine whether intracoronary pro-urokinase or tirofiban improves myocardial reperfusion during primary percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI).</p><p><bold>Methods:</bold> The study included patients with acute STEMI presenting within 12 h of symptoms at 11 hospitals in China between November 2015 and July 2017. Patients were randomized to receive selective intracoronary infusion of recombinant pro-urokinase (20 mg), tirofiban (10 μg/kg), or saline (20 mL) proximal to the infarct-related lesion over a 3-min period before stent implantation during primary PCI. The primary outcome was final corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC) after PCI.</p><p><bold>Results:</bold> This study included 345 patients. Initial angiography identified a high-grade thrombus (TIMI 4–5) in 80% of patients. Final CTFC after PCI was significantly lower in the pro-urokinase (<italic>P</italic> &lt; 0.001) and tirofiban (<italic>P</italic> &lt; 0.001) groups than in the saline group and similar between the pro-urokinase and tirofiban groups (<italic>P</italic> &gt; 0.05). The pro-urokinase (<italic>P</italic> = 0.008) and tirofiban groups (<italic>P</italic> = 0.022) had more complete ST-segment resolution at 2 h and lower peak creatine kinase-MB levels after PCI than the saline group (<italic>P</italic> = 0.006 and <italic>P</italic> = 0.023). The 30-day incidence of major adverse cardiac events was 4.5% in the pro-urokinase group, 3.4% in the tirofiban group, and 2.6% in the saline group. The incidence of in-hospital TIMI major bleeding events was low and comparable between groups.</p><p><bold>Conclusions:</bold> Adjunctive intracoronary pro-urokinase or tirofiban given before stent implantation during primary PCI improves myocardial reperfusion without increasing the incidence of major bleeding events.</p>