The Recent Cardiovascular Events Research Of Antiplatelet Treatment On The STEMI At Pre-hospital Care

Objective: Since entering the 21 st century,cardiovascular disease have became the key point of the public health problem in worldwide and the greatest threat to human health. The Acute Coronary Syndrome which include unstable angina(UA), ST-segment elevation acute myocardial infarction(STEMI) and non ST-segment elevation acute myocardial infarction(NSTEMI) come out top in cardiovascular disease,and the fatality rate of STEMI is largest in ACS. With the establish and develop of emergency medical service system(EMSS), majority of AMI patients can receive the rescue and transform of professional emergency doctor, and the sudden death probility has decreased obviously. The antiplatelet treatment is deemed to the basis treatment of ACS, and different studies have conformed that the effect of dual antiplatelet therapy with aspirin and colpidogrel is superior to antiplatelet therapy alone with aspirin. But dual antiplatelet therapy was applied and studied rarely in emergency. We design this study to observe the curative effect of dual antiplatelet treatment on ST-segment elevation acute myocardial infarction(STEAMI) patient at pre-hospital care, in order to guide the treatment on STEAMI patient at pre-hospital care.Methods: 41 patients who probable diagnosed to STEAMI with symptom and electrocardiogram were rescued and transported to hospital at Pre-hospital emergency department of Shijiazhuang Third Hospital from 2013, 3 to 2014, 9. According to the electrocardiogram, we inform that those 41 patients include 17 anterior myocardial infarction(2 patients died in transit), 15 inferior myocardial infarction(1 patient died in transit), 2 anteroseptal myocardial infarction, 3 anterolateral and 4 extensive anterior myocardial infarction(3 patients died at emergency scene). All of the patients were divided into the study group(19 cases included, 8 males and 11 females respectively) and the control group(22 cases included, 9 males and 13 females respectively) with completely randomly. There was 3 patients(2 study group, 1 control group) died because cardiopulmonary arrest at emergency scene and 3(1 study group, 2 control group) patients died in transit. At last 35(16 males and 19 females respectively) patients were selected as objects of the study, and those patients include 15 anterior myocardial infarction, 14 inferior myocardial infarction, 2 anteroseptal myocardial infarction, 3 anterolateral and 1 extensive anterior myocardial infarction. And the two groups became to the study group(16 cases included, 7 males and 9 females respectively) and control group(19 cases included, 9 males and 10 females respectively). Those patients were diagnosed as STEAMI according to the heart enzymologychech and coronary angiogram. All objects were prescribed with oxygen uptake, venous transfusion, analgesia, prevent and treat arrhythmia, drugs according to the complication, and were transferred to the nearest or other hospital which can provide coronary angiogram simultaneously. Give the patients of study group antiplatelet treatment(aspirin 300 mg, clopidogrel 600mg) in the meantime. The control group paitents’ antiplatelet treatment began after transported to hospital. The time difference of antiplatelet treatment between two group is 20~53 minutes, 35.5 minutes averagely. The time between attack to coronary angiogram was 45~73 minutes, 60 minutes average, there’s no significant difference between two groups. Keep a record of patient’s identification(age and gender), anamnesis, smoking and drinking history, result of coronary angiogram(lesion vessel and number) and the Gensini integral. Recent cardiovascular events was defined as recurrent angina, acute myocardial infarction(AMI), stroke, cardiac death, and clinical death is the outcome event. The adverse effect include gastrointestinal discomfort, melena, fatal bleeding etc.Analyze the data with SPSS 16.0 to compare the two groups’ recent cardiovascular events have significant difference or not.Results: There is no significant difference(P>0.05) in patient’s identification, anamnesis and past medicine, result of coronary angiogram and Gensini integral. The recent cardiovascular event was distinct reduced to 3 cases(18.75%) in study group as 11 cases(57.89%) in control group, have significant difference(P<0.05) about efficiency. Both of two groups have no fatal bleeding case. The rate of adverse effect was similar, 6 gastrointestinal discomfort cases in study group(37.50%), 3 melena cases(18.75%), 7 gastrointestinal discomfort cases in control group(26.84%), 3 melena cases(15.79%), there were no significant difference(P<0.05) between two groups.Conclusion: Antiplatelet Treatment on ST-segment elevation acute myocardial infarction patient at pre-hospital can instinct reduce the recent cardiovascular events, and there is no increase of adverse effect such as fatal bleeding and gastrointestinal discomfort.