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Page 6 of 8 Qin et al. Vessel Plus 2020;4:2 I http://dx.doi.org/10.20517/2574-1209.2019.22

Table 5. Logistic regression analysis
Exposure Non-Adjusted Adjusted I Adjusted II
Pro-UK group 1.0 1.0 1.0
Control group 0.77 (0.47, 1.27) 0.3036 0.73 (0.44, 1.22) 0.2292 0.79 (0.44, 1.44) 0.4475
Adjusted model I: adjusted for sex and age; adjusted model II: adjusted for sex, age, hypertension, hyperlipidemia, diabetes, smoking,
number of stents implanted, number of balloons used, Killip, post-PCI TIMI classification, time from symptom onset to balloon dilatation,
and time from admission to balloon dilatation. Pro-UK: prourokinase; PCI: percutaneous coronary intervention; TIMI: thrombolysis in
myocardial infarction
DISCUSSION
Emergency PCI can open IRAs in a timely and effective manner and can improve clinical prognosis.
However, studies have shown that approximately 30%-50% of STEMI patients do not achieve effective
[2]
[3]
myocardial reperfusion after PCI. Kaul et al. pointed out that myocardial perfusion disorder is an
independent predictor of poor prognosis after emergency PCI. Considering that the burden of coronary
artery thrombosis in patients with STEMI is often heavy, the compression of a balloon or stent during
emergency PCI may result in the fragmentation and shedding of thrombi. The microthrombi that comprise
thrombus segments detach from unstable plaques and aggregate with platelets, resulting in slow blood
[4,5]
flow/no reflow .

As part of a new generation of thrombolytic drugs, rhPro-UK can selectively activate fibrin-binding
fibronase, converting fibronase into fibrase, which can dissolve thrombi and reduce the thrombus burden.
rhPro-UK can prevent the occurrence of slow blood flow/no reflow during emergency PCI and does
not affect the coagulation function of the whole body. In recent years, the treatment of intracoronary
[6]
thrombolysis in PCI has represented a new era for thrombolysis/PCI combination therapy. Sezer et al.
found that the intracoronary injection of streptokinase immediately after direct PCI can effectively
[7]
increase myocardial perfusion. A domestic study by Zhao et al. showed that rhPro-UK had a high
effectiveness for opening IRAs, and the incidence of bleeding complications was low, thus rhPro-UK is a
safe treatment method. In another study, Zhao et al. showed that mechanical thrombectomy combined
[8]
with rhPro-UK thrombolysis presented a more favorable efficiency in the treatment of moderate to
severe acute cerebral infarction than single treatment, and the occurrence of adverse effects was similar
between the combination and single treatments. In two other recent basic studies in animal models [9,10] ,
the results of the studies proved that rhPro-UK promoted thrombolysis and recanalization (patency rate)
and did not increase the risk of bleeding. The abovementioned studies confirmed that the use of rhPro-
UK can effectively promote thrombolysis without increasing the risk of bleeding. Our study showed
that there was no difference in postoperative gastrointestinal bleeding and bleeding events between the
two groups, suggesting that it is safe to administer rhPro-UK to IRAs through guiding catheters. The
[11]
results are consistent with the abovementioned research results. In a recent study , in patients with
STEMI complicated with a long delay in PCI, emergency PCI combined with rhPro-UK thrombolysis
[11]
showed significantly better myocardial perfusion of IRAs than direct PCI. Geng et al. showed that the
intracoronary injection of rhPro-UK through a balloon catheter could effectively improve myocardial
perfusion in patients with STEMI. Our results show that the postoperative blood flow TIMI classification
in the Pro-UK group was significantly higher than that before operation. Although there was a significant
difference in the postoperative TIMI classification between the two groups, as a result of the degree of the
thrombus load in the Pro-UK group, there was no difference in the ST return rate, color sonography, and
MACEs between the two groups, suggesting that the administration of rhPro-UK to IRAs through guiding
catheters is effective, which is consistent with the abovementioned results.

[12]
Previous studies have shown that rhPro-UK can be injected into the coronary artery in a variety of
ways, such as guiding catheters, microcatheters, suction catheters, and drug balloons. Microcatheters or
suction catheters require the guide wire to be withdrawn before drug injection and for the guide wire to