Single Bolus r-SAK Before Primary PCI for ST-Segment–Elevation Myocardial Infarction-Reference-Cited by-同舟云学术

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

Published:2024-02 Issue:2 Volume:17 Page:
ISSN:1941-7640
Container-title:Circulation: Cardiovascular Interventions
language:en
Short-container-title:Circ: Cardiovascular Interventions

Author:

Chen Pengsheng¹²,Eikelboom John W.³^ORCID,Tan Chunyue¹,Zhang Wenhao¹^ORCID,Xu Yi⁴^ORCID,Bai Jianling⁵,Wang Jun⁴,Wang Tong¹⁶,Gong Xiaoxuan¹^ORCID,Liu Kun¹⁷,Chen Xin⁸,Wang Xiaoyan⁹,Zhu Li¹⁰^ORCID,Zhao Xin¹¹,Yang Naiquan¹²,Jiang Jun¹³^ORCID,Pu Jun¹⁴^ORCID,Zhao Bo⁷,Chen Zengguang⁸^ORCID,Li Baihong⁹,Wang Guoyu¹⁰^ORCID,Lu Chuan¹¹^ORCID,Ying Lianghong¹²^ORCID,Jiang Meng¹⁴^ORCID,Zhu Xiaomei⁴^ORCID,Ma Jiazheng¹^ORCID,Dong Zhou¹,Li Chen¹^ORCID,Zong Jiaxin¹,Zhang Fumin¹,Zhu Jun¹⁵,Huang Jun¹,Kong Xiangqing¹^ORCID,Yu Hao⁵,Li Chunjian¹^ORCID,

Affiliation:

1. Departments of Cardiology (P.C., C.T., W.Z., T.W., X.G., K.L., J.M., Z.D., Chen Li, J. Zong, F.Z., J.H., X.K., Chunjian Li), the First Affiliated Hospital of Nanjing Medical University, China.

2. Department of Cardiology, Xuzhou Central Hospital, Jiangsu, China (P.C.).

3. Department of Medicine, McMaster University or Thrombosis Service, Hamilton General Hospital, ON, Canada (J.W.E.).

4. Radiology (Y.X., J.W., X. Zhu), the First Affiliated Hospital of Nanjing Medical University, China.

5. Department of Biostatistics, Nanjing Medical University, Jiangsu, China (J.B., H.Y.).

6. Department of Cardiology, the First People’s Hospital of Yancheng, Jiangsu, China (T.W.).

7. Department of Cardiology, the First People’s Hospital of Lianyungang, Jiangsu, China (K.L., B.Z.).

8. Department of Cardiology, the Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Jiangsu, China (X.C., Z.C.).

9. Department of Cardiology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China (X.W., B.L.).

10. Department of Cardiology, Taizhou People’s Hospital, Jiangsu, China (L.Z., G.W.).

11. Department of Cardiology, the Second Hospital of Dalian Medical University, Liaoning, China (X. Zhao, C. Lu).

12. Department of Cardiology, Huai’an Second People’s Hospital Affiliated to Xuzhou Medical University, Jiangsu, China (N.Y., L.Y.).

13. Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, China (J.J.).

14. Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, China (J.P., M.J.).

15. Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing, China (J. Zhu).

Abstract

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. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT05023681.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Reference31 articles.

1. ST-segment elevation myocardial infarction in China from 2001 to 2011 (the China PEACE-Retrospective Acute Myocardial Infarction Study): a retrospective analysis of hospital data

2. Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association

3. Post-Myocardial Infarction Heart Failure

4. Cardiovascular remodelling in coronary artery disease and heart failure

5. Cardiovascular disease in Europe: epidemiological update 2016

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