Single Bolus r-SAK Before Primary PCI for ST-Segment-Elevation Myocardial Infarction

被引：3

作者：

Chen, Pengsheng ^{[1
,3
]}

Eikelboom, John W. ^{[4
]}

Tan, Chunyue ^{[1
]}

Zhang, Wenhao ^{[1
]}

Xu, Yi ^{[2
]}

Bai, Jianling ^{[5
]}

Wang, Jun ^{[2
]}

Wang, Tong ^{[1
,6
]}

Gong, Xiaoxuan ^{[1
]}

Liu, Kun ^{[1
,7
]}

Chen, Xin ^{[8
]}

Wang, Xiaoyan ^{[9
]}

Zhu, Li ^{[10
]}

Zhao, Xin ^{[11
]}

Yang, Naiquan ^{[12
]}

Jiang, Jun ^{[13
]}

Pu, Jun ^{[14
]}

Zhao, Bo ^{[7
]}

Chen, Zengguang ^{[8
]}

Li, Baihong ^{[9
]}

Wang, Guoyu ^{[10
]}

Lu, Chuan ^{[11
]}

Ying, Lianghong ^{[12
]}

Jiang, Meng ^{[14
]}

Zhu, Xiaomei ^{[2
]}

Ma, Jiazheng ^{[1
]}

Dong, Zhou ^{[1
]}

Li, Chen ^{[1
]}

Zong, Jiaxin ^{[1
]}

Zhang, Fumin ^{[1
]}

Zhu, Jun ^{[15
]}

Huang, Jun ^{[1
]}

Kong, Xiangqing ^{[1
]}

Yu, Hao ^{[5
]}

Li, Chunjian ^{[1
,16
]}

机构：

[1] Nanjing Med Univ, Affiliated Hosp 1, Dept Cardiol, Nanjing, Peoples R China

[2] Nanjing Med Univ, Affiliated Hosp 1, Dept Radiol, Nanjing, Peoples R China

[3] Xuzhou Cent Hosp, Dept Cardiol, Xuzhou, Jiangsu, Peoples R China

[4] McMaster Univ, Hamilton Gen Hosp, Dept Med, Thrombosis Serv, Hamilton, ON, Canada

[5] Nanjing Med Univ, Dept Biostat, Nanjing, Jiangsu, Peoples R China

[6] First Peoples Hosp Yancheng, Dept Cardiol, Yancheng, Jiangsu, Peoples R China

[7] First Peoples Hosp Lianyungang, Dept Cardiol, Lianyungang, Jiangsu, Peoples R China

[8] Nanjing Med Univ, Affiliated Changzhou Peoples Hosp 2, Dept Cardiol, Nanjing, Jiangsu, Peoples R China

[9] Jiangnan Univ, Dept Cardiol, Affiliated Hosp, Wuxi, Jiangsu, Peoples R China

[10] Taizhou Peoples Hosp, Dept Cardiol, Taizhou, Jiangsu, Peoples R China

[11] Dalian Med Univ, Hosp 2, Dept Cardiol, Dalian, Liaoning, Peoples R China

[12] Xuzhou Med Univ, Huaian Peoples Hosp 2, Dept Cardiol, Xuzhou, Jiangsu, Peoples R China

[13] Zhejiang Univ, Affiliated Hosp 2, Dept Cardiol, Sch Med, Hangzhou, Peoples R China

[14] Shanghai Jiao Tong Univ, Renji Hosp, Sch Med, Dept Cardiol, Shanghai, Peoples R China

[15] Fuwai Hosp, Natl Ctr Cardiovasc Dis, Dept Cardiol, Beijing, Peoples R China

[16] Nanjing Med Univ, Affiliated Hosp 1, Dept Cardiol, 300 Guangzhou Rd, Nanjing 210029, Peoples R China

来源：

CIRCULATION-CARDIOVASCULAR INTERVENTIONS | 2024年 / 17卷 / 02期

关键词：

follow-up studies; myocardial infarction; percutaneous coronary intervention; prospective studies; random allocation; PERCUTANEOUS CORONARY INTERVENTION; TREATED STEMI PATIENTS; PRIMARY ANGIOPLASTY; DOSE ALTEPLASE; FACILITATED PCI; ARTERY PATENCY; PLUS ABCIXIMAB; TRIAL; FIBRINOLYSIS; CLOPIDOGREL;

D O I：

10.1161/CIRCINTERVENTIONS.123.013455

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND: It is uncertain whether adjunctive thrombolysis is beneficial for patients with ST-segment-elevation myocardial infarction undergoing percutaneous coronary intervention (PCI) within 120 minutes of presentation. This study was to determine whether in patients presenting with ST-segment-elevation myocardial infarction a single bolus recombinant staphylokinase (r-SAK) before timely PCI leads to improved patency of the infarct-related artery and reduces the infarct size. METHODS: This is an open-label, prospective, multicenter, randomized study. We enrolled patients aged 18 to 75 years who were within 12 hours of symptom onset of ST-segment-elevation myocardial infarction and expected to undergo PCI within 120 minutes. Patients were administered loading doses of aspirin and ticagrelor and intravenous heparin and were randomized to receive 5 mg bolus of r-SAK or normal saline intravenously before PCI. The primary end point was Thrombolysis in Myocardial Infarction flow grade 2 to 3 or grade 3 in the infarct-related artery 60 minutes after thrombolysis. The infarct size was detected by cardiac magnetic resonance 5 days after randomization. The safety end point was major bleeding (Bleeding Academic Research Consortium >= 3) during 30-day follow-up. RESULTS: A total of 283 patients were screened from 8 centers and 200 were randomized (median age, 58.5 years; 14% female). The median symptom to thrombolysis time was 252.5 (interquartile range, 142.8-423.8) minutes and thrombolysis to coronary arteriography was 50.0 (interquartile range, 37.0-66.0) minutes. Patients randomized to r-SAK compared with normal saline more often had Thrombolysis in Myocardial Infarction flow grade 2 to 3 (69.0% versus 29.0%; P<0.001) and Thrombolysis in Myocardial Infarction flow grade 3 (51.0% versus 18.0%; P<0.001) and had smaller infarct size (21.91 +/- 10.84% versus 26.85 +/- 12.37%; P=0.016). There was no increase in major bleeding (r-SAK, 1.0% versus control, 3.0%; P=0.616). CONCLUSIONS: A single bolus r-SAK before primary PCI for ST-segment-elevation myocardial infarction improves infarct-related artery patency and reduces infarct size without increasing major bleeding.

引用

页数：12

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