| Objectives: There were a lot of clinical trials which confirmed the efficacy and safety of thrombolysis in treatment of AMI.In the recent years,the effect of percutaneous transluminal coronary angioplasty (PTCA) proved to be better than that of thrombolysis.The purpose of this study was: to evaluate the effect and safety of emergency percutaneous coronary intervention(PCI) and intravenous thrombolysis for acute myocardial infartion(AMI); to investigate the mechanism of and the optimal strategies for myocardial no-reflow phenomenon after reperfusion therapy ; to research on the factors that influence myocardial reperfusion;and to provide more effective method and the evidences of it for treatment of AMI; to investigate the value of low dose thrombolytic agent(rt-PA) combined with rescued PCI; to evaluate the value of distal protection device in PCI; and to investigate the influence of reperfusion methods on the type and frequency of reperfusion arrhythmia.Methods: According to the objectives of the research, 295 patients with ST elevation myocardial infarction (STEMI) were assigned to the PCI group(n=158) or the thrombolysis group(n=137).In the PCI group,emergency coronary angiography was performed within six to twelve hours after myocardial infarction.Infarct-related artery (IRA) was assessed by Thrombolysis inMyocardial Infarction (TIMI)grade. The patients with grade 0 to 2 were implanted with stents. Intracoronary nitroglycerin, dilitiazem or/and 200~300 thousand units of urokinase(UK) were used for the patients with slow reflow or no-reflow after PCI. The non-IRA in patients with stable hemodynamics and relatively easy to perform were also simultaneously implanted with stents. In the thrombolysis group, 105 patients were given with a low dose of rt-PA(50mg),32 patients with urokinase(UK, 1,500,000-2, 000,000U) .Associate drugs: In the PCI group,Aspirin,the routine anti-platelet drug was given orally in an initial dose of 300mg,then with the dose of 150mg daily,Ticlopidine was given with the dose of 250mg twice daily,or Clopidgral was given with an initial dose of 300mg,then was given with the dose of 75mg daily for three to six months.Anticoagulant therapy, unfractional heparin or low molecular weight heparin was administered for one week.In the thrombolysis group,the usage of aspirin and heparin were the same as the PCI group.Both groups were given with nitrate ,ACEI and P-receptor blockers and so on according to the condition of the patients.Evaluation of the curative effects: In the PCI group, the effect of recanalization of the IRA was evaluated by TIMI grade.In the thrombolysis group, the effect of recanalization and the complications were evaluated by the Reference Program of Thrombolytic Effect in AMI by the Committee of Chinese Journal of Cardiology. Evaluation of myocardial function: two-dimensional ultrasonography was used to measure the left ventricular ejection fraction (LVEF).The incidences of the death and the major adverse cardiac events (MACE) were counted.Results: In the PCI group,147 patients with TIMI grade 0-2 were implanted(102 with grade 0,29 with grade 1,16 with grade 2). 143 patients were successfully implanted,but 4 patients were implanted in failure(2 patients with no arrival of the lesion with the stents ,1 patient with TIMI grade 0 and 1 patient with grade 1 after stenting).198 stents,of which 165 stents into IRA and 33 stents into non-IRA in 27 patients, were implanted into the patients, 129 patientswith one stent each and 18 patients with two stents each.The TIMI grade after stenting : grade 3 (n=138), grade 2 (n=7), grade 1 (n=l), grade 0 (n=l).grade 2 is confined to slow-reflow,and grade 0 to 1 was no-flow. 9(6.1%) patients with slow-reflow or no-reflow were injected introcoronarily withnitroglycerin(200ng) and diltiazem(500p.g),4 patients with quantity of thrombi were injected introcoronarily with UK(300,000U).TIMI grade was improved in 6 patients,in which 4 patients acquired grade 3.In the stent-implanting group, 85 of the 147 patients were directly stented, because the distant vessels to the occluded lesion emerged after the guide wire crossed through the occlusion and after intracoronary nitroglycerin were injected ,and 60 patients were stented after the balloon dilatation. While treating the IRA,the non-IRA were stented simultaneously in 27 patients with 41 stents. In the thrombolysis group ,reperfusion were found in 92 of the 137 patients(67.2%),34 patients were rescued by percutaneous coronary stent implantation with 36 stents implanted.The incidences of the MACE in hospital which included cardiogenic death, reinfarction and reintervention was 8.2% in the PCI group(13/158),and 20.4% in the thrombolysis group(28/137).LVEF in the PCI group were significantly higher than that in the thrombolysis group(63.2 + 12.3%,51.4±3.4%;P<0.01).In the PCI group, LVEF of the patients with TIMI grade 3 was significantly greater than that of the patients with grade 0 to 2.In the thrombolysis group ,LVEF of the successfully thrombolytic patients was significantly greater than that of the patients in failure.There was a difference in the death rate during in hospital between the PCI group and the thrombolysis group3.2%(5/158)vs 5.8%(8/137), P<0.05),but no significant difference in the rate of cerebral hemorrhage between the two groups .Conclusions:1. Direct stenting could rapidly and completely open the IRA, decreased the onset of thrombo-embolism , remarkably improved the patients' prognosis, shortened their duration in hospital,decreased the dosages of contrast and...
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