PMID- 34530593
OWN - NLM
STAT- MEDLINE
DCOM- 20210920
LR  - 20210920
IS  - 0253-3758 (Print)
IS  - 0253-3758 (Linking)
VI  - 49
IP  - 9
DP  - 2021 Sep 24
TI  - [Efficacy and safety comparison between pro-urokinase and reteplase in the 
      treatment of patients with acute ST elevation myocardial infarction].
PG  - 866-872
LID - 10.3760/cma.j.cn112148-20201103-00877 [doi]
AB  - Objective: To compare the efficacy and safety of pro-urokinase and reteplase in 
      the treatment of patients with acute ST elevation myocardial infarction (STEMI). 
      Methods: STEMI patients, who received intravenous thrombolytic therapy in Henan 
      STEMI registry between September 2016 and August 2018, were eligible for this 
      study. A total of 5479 patients from 66 hospitals were screened and patients were 
      divided into pro-urokinase group (n=638) and reteplase group (n=702) according to 
      thrombolytic drugs. Data including patient demographics, risk factors, medical 
      histories, patient information at admission, in-hospital treatment, time delays, 
      and clinical events were collected. The clinical recanalization rate, in-hospital 
      mortality, in-hospital death or treatment withdrawal, in-hospital main adverse 
      cardiovascular and cerebrovascular events (MACCE, death or treatment withdrawal, 
      congestive heart failure, reinfarction and ischemic stroke) and post-thrombolysis 
      bleeding were compared between the two groups. Bleeding events were evaluated 
      with Bleeding Academic Research Consortium (BARC) criteria. Results: The median 
      age [61.8 (53.2, 69.0) vs. 62.6 (52.1, 69.8), P=0.833] or the proportion of women 
      [23.0% (147/638) vs. 25.1% (176/702), P=0.385] were similar between the 
      pro-urokinase and reteplase groups. Clinical recanalization rates were similar 
      between the pro-urokinase and reteplase groups [82.1% (524/638) vs. 84.9% 
      (596/702), P=0.172], and there was no difference in the median time from onset to 
      thrombolysis [194.5 (135.0,290.0) min vs. 190 (126.0,292.0) min, P=0.431] and the 
      median recanalization time [95 (67.5,120.0) min vs. 95 (71.0,119.0) min, P=0.561] 
      between the two groups. There was no significant difference in in-hospital 
      mortality [5.5% (35/638) vs. 5.1% (36/702), P =0.770], in-hospital all-cause 
      mortality, treatment withdrawal [8.9% (57/638) vs.7.7% (54/702), P=0.410], and 
      in-hospital MACCE [13.0% (83/638) vs. 10.4% (73/702), P=0.137] between 
      pro-urokinase and reteplase groups. However, the incidence of post-thrombolysis 
      bleeding was significantly higher in reteplase group than in pro-urokinase group 
      [7.8% (55/702) vs. 3.8% (24/638), P=0.002]. Further analysis found that the 
      incidence of oral bleeding and the BARC grades 1-2 bleeding were significantly 
      higher in reteplase group than in pro-urokinase group, whereas the incidence of 
      cerebral hemorrhage was similar between the two groups [0.6% (4/638) vs. 0.4% 
      (3/702), P=0.715]. The comparison of efficacy and safety outcomes between the two 
      groups after adjusting for baseline characteristics using general linear mixed 
      models was consistent with those before the adjustment. There was no significant 
      difference in in-hospital mortality, in-hospital death or treatment withdrawal, 
      in-hospital MACCE after adjusting for baseline characteristics and 
      post-thrombolysis bleeding between the two groups. Conclusions: Pro-urokinase and 
      reteplase have similar clinical efficacy in the treatment of STEMI. In terms of 
      safety, the incidence of cerebral hemorrhage is similar, while the incidence of 
      BARC grades 1-2 bleeding and oral bleeding is higher in reteplase group than in 
      pro-urokinase group, which has no impact on in-hospital outcomes.
FAU - Zhang, Y
AU  - Zhang Y
AD  - Henan Institute of Cardiovascular Epidemiology, Henan Key Laboratory for 
      Prevention and Control of Coronary Heart Disease, Central China Fuwai Hospital of 
      Zhengzhou University, Fuwai Central China Cardiovascular Hospital, Heart Center 
      of Henan Provincial People's Hospital, Zhengzhou 451464, China.
FAU - Wang, S
AU  - Wang S
AD  - Henan Institute of Cardiovascular Epidemiology, Henan Key Laboratory for 
      Prevention and Control of Coronary Heart Disease, Central China Fuwai Hospital of 
      Zhengzhou University, Fuwai Central China Cardiovascular Hospital, Heart Center 
      of Henan Provincial People's Hospital, Zhengzhou 451464, China.
FAU - Gao, C Y
AU  - Gao CY
AD  - Henan Institute of Cardiovascular Epidemiology, Henan Key Laboratory for 
      Prevention and Control of Coronary Heart Disease, Central China Fuwai Hospital of 
      Zhengzhou University, Fuwai Central China Cardiovascular Hospital, Heart Center 
      of Henan Provincial People's Hospital, Zhengzhou 451464, China.
FAU - Liu, X Y
AU  - Liu XY
AD  - Big Data Center for Cardiovascular Disease, Henan Key Laboratory for Prevention 
      and Control of Coronary Heart Disease, Central China Fuwai Hospital of Zhengzhou 
      University, Fuwai Central China Cardiovascular Hospital, Heart Center of Henan 
      Provincial People's Hospital, Zhengzhou 451464, China.
FAU - Cheng, Q Q
AU  - Cheng QQ
AD  - Henan Institute of Cardiovascular Epidemiology, Henan Key Laboratory for 
      Prevention and Control of Coronary Heart Disease, Central China Fuwai Hospital of 
      Zhengzhou University, Fuwai Central China Cardiovascular Hospital, Heart Center 
      of Henan Provincial People's Hospital, Zhengzhou 451464, China.
FAU - Zhang, J H
AU  - Zhang JH
AD  - Henan Institute of Cardiovascular Epidemiology, Henan Key Laboratory for 
      Prevention and Control of Coronary Heart Disease, Central China Fuwai Hospital of 
      Zhengzhou University, Fuwai Central China Cardiovascular Hospital, Heart Center 
      of Henan Provincial People's Hospital, Zhengzhou 451464, China.
FAU - Qi, D D
AU  - Qi DD
AD  - Henan Institute of Cardiovascular Epidemiology, Henan Key Laboratory for 
      Prevention and Control of Coronary Heart Disease, Central China Fuwai Hospital of 
      Zhengzhou University, Fuwai Central China Cardiovascular Hospital, Heart Center 
      of Henan Provincial People's Hospital, Zhengzhou 451464, China.
FAU - Wang, X P
AU  - Wang XP
AD  - Henan Institute of Cardiovascular Epidemiology, Henan Key Laboratory for 
      Prevention and Control of Coronary Heart Disease, Central China Fuwai Hospital of 
      Zhengzhou University, Fuwai Central China Cardiovascular Hospital, Heart Center 
      of Henan Provincial People's Hospital, Zhengzhou 451464, China.
FAU - Zhu, Z Y
AU  - Zhu ZY
AD  - Henan Institute of Cardiovascular Epidemiology, Henan Key Laboratory for 
      Prevention and Control of Coronary Heart Disease, Central China Fuwai Hospital of 
      Zhengzhou University, Fuwai Central China Cardiovascular Hospital, Heart Center 
      of Henan Provincial People's Hospital, Zhengzhou 451464, China.
FAU - Li, M W
AU  - Li MW
AD  - Henan Institute of Cardiovascular Epidemiology, Henan Key Laboratory for 
      Prevention and Control of Coronary Heart Disease, Central China Fuwai Hospital of 
      Zhengzhou University, Fuwai Central China Cardiovascular Hospital, Heart Center 
      of Henan Provincial People's Hospital, Zhengzhou 451464, China.
FAU - Hu, D Y
AU  - Hu DY
AD  - Institute of Cardiovascular Disease, Peking University People's Hospital, Beijing 
      100044, China.
LA  - chi
GR  - 20160210, 201702218/Projects of Scientific and Technological Support Plan of 
      Health Commission of Henan Province/
PT  - Journal Article
PL  - China
TA  - Zhonghua Xin Xue Guan Bing Za Zhi
JT  - Zhonghua xin xue guan bing za zhi
JID - 7910682
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Recombinant Proteins)
RN  - DQA630RIE9 (reteplase)
RN  - EC 3.4.21.68 (Tissue Plasminogen Activator)
RN  - EC 3.4.21.73 (Urokinase-Type Plasminogen Activator)
RN  - U5NH2JV64T (saruplase)
SB  - IM
MH  - Female
MH  - Fibrinolytic Agents/therapeutic use
MH  - Hospital Mortality
MH  - Humans
MH  - *Myocardial Infarction/drug therapy
MH  - Recombinant Proteins
MH  - *ST Elevation Myocardial Infarction/drug therapy
MH  - Thrombolytic Therapy
MH  - Tissue Plasminogen Activator
MH  - Treatment Outcome
MH  - Urokinase-Type Plasminogen Activator
EDAT- 2021/09/18 06:00
MHDA- 2021/09/21 06:00
CRDT- 2021/09/17 03:54
PHST- 2021/09/17 03:54 [entrez]
PHST- 2021/09/18 06:00 [pubmed]
PHST- 2021/09/21 06:00 [medline]
AID - 10.3760/cma.j.cn112148-20201103-00877 [doi]
PST - ppublish
SO  - Zhonghua Xin Xue Guan Bing Za Zhi. 2021 Sep 24;49(9):866-872. doi: 
      10.3760/cma.j.cn112148-20201103-00877.