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Page 2 of 8 Qin et al. Vessel Plus 2020;4:2 I http://dx.doi.org/10.20517/2574-1209.2019.22

Conclusion: The intracoronary injection of recombinant human prourokinase in patients with STEMI undergoing
emergency PCI is safe and effective.

Keywords: ST-segment elevation myocardial infarction, primary percutaneous coronary intervention, recombinant human
prourokinase, infarction-related artery

INTRODUCTION
[1]
The guidelines of the European Society of Cardiology recommend percutaneous coronary intervention
(PCI) as the preferred strategy for reperfusion therapy in patients with acute ST-segment elevation
myocardial infarction (STEMI). However, when the thrombus load in the coronary artery is heavy, PCI
cannot effectively remove the thrombus and increases the risk of thrombus shedding, leading to the
occurrence of “slow blood flow” and “no reflow” in the distal infarction-related artery (IRA). For STEMI
patients with a high coronary artery thrombus load, the treatment strategy is particularly critical, which
has puzzled interventional doctors. The purpose of this study was to analyze the safety and efficacy of the
intraoperative injection of recombinant human prourokinase (rhPro-UK) in STEMI patients with a high
thrombus load during emergency PCI with IRA.

METHODS
Patient enrollment
From April 2017 to December 2018, 312 patients from the First People’s Hospital of Changde City met the
diagnostic criteria of STEMI based on the 2014 guidelines for the diagnosis and treatment of acute STEMI.
All patients underwent emergency PCI, and the IRA was successfully opened. These patients were divided
into two groups. Patients with high thrombus loads, which had been confirmed by coronary angiography,
were treated with rhPro-UK by guiding catheter infusion into the proximal end of the IRA, and were
placed in the Pro-UK group (n = 127). There were 109 males and 18 females in this group. The age of the
Pro-UK patients ranged from 20 to 86 years old, and the average age was 59.56 ± 12.58 years old. Among
these patients, 7 patients underwent percutaneous transluminal coronary angioplasty (PTCA) and 120
underwent PCI. Six people were treated with an intra-aortic balloon pump and 23 patients were treated
with temporary pacemakers. For the affected vessels, there were 2 cases in the left trunk, 56 cases in the
anterior descending branch, 8 cases in the circumflex branch, and 61 cases in the right coronary artery.

Study protocol
Pro-UK group: according to a high thrombus load, as confirmed by coronary angiography, the patients
were treated with the intracoronary infusion of urokinase to the IRA. rhPro-UK was injected into the
coronary artery, into a minimum of one branch, a maximum of nine branches (5 mg/branch), and a
median of two branches. Seven patients underwent PTCA and 120 underwent PCI.

Control group: in patients who did not have a high thrombus load during the operation, rhPro-UK was not
injected into the coronary artery. Eight patients underwent PTCA and 177 underwent PCI.

Both groups were given aspirin 300 mg, clopidogrel 300/600 mg, or Ticagrelor 180 mg immediately before
the beginning of PTCA, followed by 100 mg/qd, 75 mg/qd or 90 mg/bid, respectively.

Statistical methods
If measurement data had a normal distribution, the mean ± standard deviation (x ± s) are shown, and
the difference between groups was compared by a t test. If the data had a nonnormal distribution, they
are represented by the median and quartile limits [M (Q1, Q3)], and the differences between these groups