Comparison of myocardial microcirculatory perfusion after catheter‐administered intracoronary thrombolysis with anisodamine versus standard thrombus aspiration in patients with ST‐elevation myocardial infarction

Abstract

Objective To evaluate efficacy, safety and feasibility of targeted intracoronary injection using pro‐urokinase combined with anisodamine (TCA) versus thrombus aspiration (TA) in ST‐elevation myocardial infarction (STEMI) patients with high thrombus loads. Background The best method of avoiding thrombus detachment and stroke in PCI patients with high thrombus loads has not yet been established. Methods STEMI patients receiving coronary artery angiography or percutaneous coronary intervention (CAG/PCI) with thrombus grade ≥ 3 from January 1, 2017 to June 30, 2018 were randomly assigned to targeted intracoronary thrombolysis (pro‐urokinase and anisodamine via catheter (TCA) group), or the TA group which followed the standard thrombus aspiration procedure. Parameters compared included thrombus grade, index of microcirculatory resistance (IMR), postoperative myocardial SPECT, thrombosis in myocardial infarction (TIMI) scores including flow grade, corrected TIMI frame counts (CTFCs), and TIMI myocardial perfusion grade (TMPG). Adverse events were followed up within 3 months. Results Thirty‐nine patients were finally enrolled. In primary CAG/PCI, the TCA group had higher percentages of TIMI 3 flow and lower IMR values compared with the TA group. The ratio of TMPG 3 grade in the TCA group was higher in repeat CAG, and the perfusion descending area (PDA) presented by SPECT was lower than in the TA group. No significant difference was seen in major adverse coronary events (MACEs) or bleeding events at follow‐up. Conclusions TCA appears to be effective, safe, and feasible for repatency and reduction of high thrombus burden in primary PCI and may protect myocardial microcirculation with improved outcomes.

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

“…Although routine thrombus aspiration is not recommended during primary PCI, thrombus aspiration may be considered in cases where a large residual thrombus burden is encountered after opening the vessel with the wire or balloon ( 9 , 12 ). About 80% of the patients in our trial had high-grade thrombus (TIMI 4–5) in the culprit artery, and around half the patients underwent manual thrombus aspiration, which is a higher proportion than that reported in other studies of intracoronary tirofiban or fibrinolytic therapy ( 21 – 23 , 38 , 39 ). Importantly, thrombus aspiration was not associated with stroke or transient ischemic attack in our trial.…”

“…Another randomized clinical trial utilized low-dose alteplase (10-20 mg) for intracoronary administration (21). The dose of pro-UK used in the present study was selected based on the results of previous investigations, which suggested that local administration of 10-20 mg pro-UK could promote thrombus dissolution and improve myocardial perfusion without increasing the incidence of major bleeding events (38,39). In order to reduce the risk of bleeding complications in this study, patients with risk factors for bleeding were excluded, and the PCI procedures were performed via the radial artery.…”

Intracoronary pharmacological therapy versus aspiration thrombectomy in STEMI (IPAT-STEMI): A systematic review and meta-analysis of randomized trials

“…Eleven corresponding authors were contacted for missing data, two of them responded, and only one provided clarification. Twelve trials [ 77 – 88 ] were included after eliminating 64 studies for various reasons (S3 Table in S1 File ). In addition, results from a one-year follow-up [ 89 ] of one included study [ 83 ] were considered in the quantitative analysis.…”

“…The 12 trials enrolling 1,466 patients were conducted in different countries between 2009 and 2018. Six studies recruiting 647 patients (44.1%) were from China [ 77 , 79 , 80 , 85 , 86 , 88 ]. Recruitment periods ranged from 0.5 to 5.4 years and sample size from 39 to 452 patients.…”

Efficacy and safety of intracoronary prourokinase during percutaneous coronary intervention in treating ST-segment elevation myocardial infarction patients: a randomized, controlled study

“…The sample size of this study was calculated based on previous studies [13,14]. Assuming the IMR in the intracoronary prourokinase group was 30 U (SD = 10) and 40 U (SD = 13) in the control group, with a power of 90%, a two-sided 5% level of significance (α) and a sample size ratio of 1:1, required a sample size of 20 participants in the intracoronary prourokinase group and 20 in control group.…”