Key result
Sequential tPA and prourokinase emerges as a proposed alternative to PCI to avoid reperfusion delays.
Why the study?
PCI for AMI involves inevitable reperfusion delays that increase mortality, and is unsuitable for vessels smaller than the catheter.
Does a sequential combination of tissue-type plasminogen activator and prourokinase reduce reperfusion delay and mortality compared to PCI in patients with acute myocardial infarction or ischemic stroke?
Does a sequential combination of tissue-type plasminogen activator and prourokinase reduce reperfusion delay and mortality compared to PCI in patients with acute myocardial infarction or ischemic stroke?
This review challenges the primacy of PCI for AMI, arguing that the sequential combination of tissue-type plasminogen activator and prourokinase may be more effective by avoiding reperfusion delays.
Should not yet change PCI preference in AMI or stroke; leaves open whether sequential thrombolysis reduces reperfusion delays.
The current treatment of choice for an acute myocardial infarction (AMI) is an interventional procedure like percutaneous coronary intervention (PCI), which takes 2 to 3 hours and is not appropriate for clots in arteries smaller than the catheter. Because PCI requires inpatient catheterization, there is an inevitable delay in reperfusion of the ischemia. This delay was shown to have a linear relationship with AMI mortality. The longer the delay, from <5 minutes to >3 hours, the greater the cardiovascular disease mortality. Instead of PCI, a sequential combination of tissue-type plasminogen activator and prourokinase is the most effective treatment for conditions like AMI and ischemic stroke that mirrors the endogenous fibrinolytic process.
No takes yet. Share an insight, caveat, or question.
Gurewich et al. (2025) conducted a review in Acute myocardial infarction (AMI) and ischemic stroke. Sequential combination of tissue-type plasminogen activator and prourokinase vs. Percutaneous coronary intervention (PCI) was evaluated. A sequential combination of tissue-type plasminogen activator and prourokinase is proposed as an effective alternative to PCI for AMI and ischemic stroke to avoid reperfusion delays.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: