Efficacy and Safety of a Half-dose Bolus of r-SAK Prior to Primary PCI in ST-elevation Myocardial Infarction

Prior treatment

• Severe trauma, surgery or head injury within 1 month
• Currently taking anticoagulants
• Having taken antiplatelet drugs other than aspirin and ticagrelor, such as clopidogrel, prasugrel or cilostazol after the symptom onset

Other illness

• Active bleeding or known at high risk of bleeding (including grade Ⅲ or Ⅳ retinopathy or retinal gastrointestinal or urinary tract hemorrhage within the past 6 month)
• Ischemic stroke or TIA in the past 6 months
• History of hemorrhagic stroke
• Poorly controlled hypertension ( ≥180/110 mmHg)
• Known allergy to r-SAK
• History of chronic total occlusion, myocardial infarction or CABG
• Patients with other conditions that made them unsuitable to be recruited at the discretion of the investigators

Lab values

• Known history of anemia with hemoglobin level \<10 g/dL
• Known history of thrombocytopenia with platelet count \<100×10⁹/L
• Severe hepatic or renal impairment indicated by the consultation or previous history (glutamic-pyruvic transaminase or glutamic oxalacetic transaminase \>3 times upper limit of normal value; eGFR \<15 ml/min/1.73m\^2, calculated based on CKD-EPI)

Other

• Cardiogenic shock
• Known intracranial aneurysm
• Suspected aortic dissection or infective endocarditis
• Puncture with difficult hemostasis by compression within 1 month (e.g., visceral biopsy, compartment puncture)
• Pregnancy, lactation, or planning for pregnancy

• Age 18-75 years, weight ≥45 kg
• Diagnosed as STEMI (meeting the following two conditions simultaneously)
  • Ischemic chest pain lasts ≥ 30 minutes
  • ECG indicates that ST-segment elevation of two or more contiguous precordial leads ≥ 0.1 mV, or ST-segment elevation of two or more contiguous precordial leads ≥ 0.2 mV
• Time from onset of persistent chest pain to randomization ≤12 hours
• Primary PCI expected to be performed ≥30 minutes, and ≤120 minutes