| Objectives: To investigate the safety and efficacy of early percutaneous coronary intervention (early PCI) in patients with non-ST Segment elevation infarction (NSTEMI) through comparing the reperfusion of coronary arteries, myocardium perfusion, systolic and diastolic functions of left ventricular, bleeding complications, cardiac hospital readmissions and major adverse cardiac events (MACE, including cardiac death, severe heart failure, reinfarction, malignant ventricular arrhythmias and target vessel revascularization) with NSTEMI patients undergoing elective PCI.Methods: Ninety-one patients (79 males) who suffered from first NSTEMI within 24 hours from symptom onset during October 2009 and July 2010 were enrolled in this study. The NSTEMI was defined according to the guideline of ACC/AHA as electrocardiographic (ECG) ST-segment depression or prominent T-wave inversion and positive biomarkers of necrosis (e.g., troponin) in the absence of ST-segment elevation with an appropriate clinical setting (chest discomfort or angina equivalent) for more than 30minutes. Exclusion criteria were including ST segment elevation in ECG, previous intracranial bleeding at any time, stroke in less than 3months, closed head or facial trauma within 3 months, and bleeding tendencies. All the cases were divided into 2 groups randomly: early PCI group (n=44) and elective PCI group (n=47). Patients in early PCI group were assigned to receive 300mg loading dose of aspirin and clopidogrel orally at admitted time, and low molecular weight heparin (enoxaparin, 100AxaIU/kg subcutaneous injection every 12 hours). Coronary angiography was performed immediately after admission, and the stent was implanted if ischemia related artery (IRA) was occluded or residual stenosis was more than 70%. Tirofiban was administered as 10ug/kg intravenous injection within 3 minutes followed by 0.15μg/ (kg·min) for 24-48 hours according to the result of coronary angiology and PCI. Patients in elective PCI group received the same medical therapies with those in early PCI group, and PCI was performed 7-10 days after admission. The other medications were administered to all the patients (including low molecular weight heparin, diuretics, isotropic agents, intravenous vasodilator, lipid-lowering, beta-blockade, angiotensin of converting enzyme inhibitors, and anticoagulation agents) according to current best practice. Baseline clinical characteristics, which were including age, gender distribution, risk factors, pre-infarction angina, infarction location, heart function, GRACE classification and bleeding were recorded and compared between the two groups. Quantitative coronary analysis (QCA) was used to analyze the lesions quantitatively, and positive lesions were defined as 70% or greater coronary lumen stenosis. Reperfusion rate, severity of coronary lesions, and classification of myocardial perfusion were observed in the two groups. TIMI flow of IRA before and after PCI, as well as TIMI Myocardial perfusion grading (TMP) after PCI were compared between the two groups. The differences of left ventricular end diastolic volume (LVEDV), Left ventricular end systolic volume (LVESV), left ventricular ejection fraction (LVEF) and MACE during hospitalization and 6-month follow-up were analyzed. SPSS 13.0 software was used for static analysis, and a P Value of less than 0.05 (2-tailed) was considered statistic significantly.Results: Baseline characteristics including age, gender distribution, risk factors of coronary heart disease, pre-infarction angina, infarction loction, IRA and GRACE classification were similar between the two groups. There were no differences in the rates of IRA total occlusion, TIMI flow grade 1, and TIMI flow grade 2 before PCI between the two groups (all P>0.05), while the rate of TIMI flow grade 3 in early PCI group was lower than that in elective group (22.73% vs. 42.55%, P<0.05). After PCI treatment, no significant differences in TIMI flow were found between the two groups, and the rate of TMP grade 2 or greater in early PCI group was higher (79.55% vs. 59.57%, P<0.05). There were no significant differences in LVEDV, LVESV, and LVEF between the two groups in hospital (129.82±31.95 vs. 132.89±29.42, 61.95±17.50 vs. 63.40±21.57,51.89±8.08% vs. 53.06±8.24% respectively, all P>0.05). After 6-month follow-up, both LVEDV and LVESV decreased significantly, and LVEF increased. The incidence of cardiac rehospitalization was lower in early PCI group, while the cardiac death, severe heart failure, reinfarction, malignant arrhythmias, revasculization of IRA, and bleeding complications were similar.Conclusions:1 Both early and elective PCI can improve the heart function in NSTEMI patients at 6months, and the effects of early PCI on improving heart function is better.2 Early PCI reduces rehospitalization in NSTEMI patients at 6months compared with elective PCI.3 No significant differences in the incidence of MACE between early PCI and elective PCI.4 Early PCI dose not increase the incidence of bleeding complications. |
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