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Long-term outcome of patients with ST-segment elevation myocardial infarction treated with low-dose intracoronary thrombolysis during primary percutaneous coronary intervention: the 5-year results of the DISSOLUTION Trial

Journal of Thrombosis and Thrombolysis volume 51, pages 212–216 (2021)Cite this article

Abstract

We tested the hypothesis that adjunctive thrombolysis at time of primary percutaneous coronary intervention (PCI) may affect favourably the long-term outcome of patients with ST elevation myocardial infarction (STEMI). To this end, we undertook a substudy of the DISSOLUTION (Delivery of thrombolytIcs before thrombectomy in patientS with ST-segment elevatiOn myocardiaL infarction Undergoing primary percuTaneous coronary interventION) trial. A total of 95 patients were randomized to local delivery of urokinase (n = 48) or placebo (n = 47). After PCI, a greater proportion of patients receiving urokinase had an improvement in myocardial perfusion, as indicated by a significantly higher final Thrombolysis in myocardial infarction (TIMI) grade 3, myocardial blush grade, and 60-min ST-segment resolution > 70%, as well as lower corrected TIMI frame count. At 1-year echocardiography, urokinase-treated patients exhibited significantly lower LV dimension, as well as higher LV ejection fraction and wall motion score index as compared with placebo-treated patients. At 5 years, major acute cardiovascular events (MACEs) were significantly less common in the urokinase group (P = 0.023), mainly due to a lower occurrence of hospitalisation for heart failure (P = 0.038). Multivariate analysis showed that factors independently associated with 5-year occurrence of MACEs were LV remodelling at 1-year echocardiography (P = 0.0001), 1-year LV ejection fraction (P = 0.0001), TIMI grade flow 0–2 (P = 0.0019), and age at time of PCI (P = 0.0173). In conclusion, low-dose intracoronary urokinase during primary PCI is associated with a more favourable 5-year outcome of patients with STEMI.

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Affiliations

  1. Department of Cardiovascular Sciences, Sapienza University, Rome, Italy

    Francesco Pelliccia, Cesare Greco, Gaetano Tanzilli, Nicola Viceconte, Michele Schiariti & Carlo Gaudio

  2. Department ‘Attilio Reale’, Sapienza University, Via del Policlinico 155, 00161, Rome, Italy

    Francesco Pelliccia

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  1. Francesco Pelliccia
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  2. Cesare Greco
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  3. Gaetano Tanzilli
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  4. Nicola Viceconte
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  5. Michele Schiariti
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  6. Carlo Gaudio
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Correspondence to Francesco Pelliccia.

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Pelliccia, F., Greco, C., Tanzilli, G. et al. Long-term outcome of patients with ST-segment elevation myocardial infarction treated with low-dose intracoronary thrombolysis during primary percutaneous coronary intervention: the 5-year results of the DISSOLUTION Trial. J Thromb Thrombolysis 51, 212–216 (2021). https://doi.org/10.1007/s11239-020-02157-w

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  • DOI: https://doi.org/10.1007/s11239-020-02157-w

Keywords

  • Left ventricular remodelling
  • Myocardial infarction
  • Outcome
  • Prognosis
  • Thrombolysis
  • Urokinase