Effect Of Pro-UK Combined With Thrombus Aspiration On STEMI Patients With High Rhrombotic Load

Objectives To investigate the efficacy and safety of thrombolysis in patients with STEMI with high thrombus load in the pro-UK combined Thrombus aspiration in PCI.Methods From October 2015 to April 2017,90 cases was diagnosed acute myocardial infarction with high thrombus load in tangshan gongren hospital.All the patients were given oral aspirin 300 mg and ticagrelor 180 mg,Intravenous heparin 70-100U/kg was given to full anti platelet aggregation and anticoagulant therapy,oxygen inhalation and electrocardiographic monitoring were given.The patients were divided into the pro-UK group(In PCI,rhpro-UK were injected at the distal end of thrombus that combined with thrombus aspiration)and the Tirofiban group(In PCI,thrombus aspiration combined with tirofiban was injected into the proximal end of thrombus).The general data of the two groups,the level of myocardial perfusion,the peak level of creatine kinase isoenzyme and troponin I,the level of fibrinogen and D-two polymer,the adverse cardiovascular events and the risk of bleeding during the hospitalization and follow-up were compared.Results 1 Among the 90 cases who met the inclusion criteria,the average age was 61.53 ± 8.53 years,and 63 males(70%).There was no significant difference in general data between the pro-UK group and the Tirofiban group(P>0.05).2 In the pro-UK group and the Tirofiban group,the number of patients recovering the TIMI blood flow 3 after PCI was 42(95.5%)cases and 41(89.1%)cases,the difference was not statistically significant(P>0.05);The number of Ctfc for myocardial infarction was 25.73±3.23 and 27.59±4.85,the number of patients with TMPG 3 was 41(93.2%)and 36(78.3%),the number of ST segments in 2h after operation was 36(81.8%)and 28(60.9%),the differences were statistically significant(P<0.05).3 The peak CK-MB in the pro-UK group was lower than that in the Tirofiban group,which was 171.41±31.41(U/L)and 186.02±30.26(U/L),the difference was statistically significant(P<0.05).The peak c Tn I in the pro-UK group was lower than that in the Tirofiban group,which was 6.34 ± 2.66(U/L)and 7.56 ± 2.74(U/L),the difference was statistically significant(P<0.05).There was no significant difference in plasma Fib level and D-D level between two groups before and after operation(24h and 48h)(P>0.05);The Fib level of 2h in the pro-UK group was lower than that before operation,which was 3.13 ± 0.65(g/L)and 3.35 ± 0.80(g/L),the difference was statistically significant(P<0.05);In the pro-UK group,the Fib level of 2h in the pro-UK group was lower than that in the Tirofiban group,3.13±0.65(g/L)and 3.35±0.62(g/L),but the difference was not statistically significant(P>0.05);The level of 2h D-D two polymer in the pro-UK group was significantly higher than that before operation,which was 4.67±0.65(mg/L)and 2.22±0.35(mg/L),the difference was statistically significant(P<0.05);The level of 2h D-D in the pro-UK group was significantly higher than that in the Tirofiban group,4.67±0.65(mg/L)and 2.31±0.28(mg/L),the difference was statistically significant(P<0.01).4 The ultrasonic cardiogram of the pro-UK group and the Tirofiban group was rechecked at 1 months after the operation,The LVEF of the pro-UK group was 47.57±8.47(%)and 56.43±3.38(%)at the time of admission and reexamination,the difference was statistically significant(P<0.05);The LVEF in the Tirofiban group at admission and reexamination was 46.52±8.14(%)and 53.74±6.10(%),the difference was statistically significant(P<0.05);The LVEF of the pro-UK group and the Tirofiban group was 56.43±3.38(%)and 53.74±6.10(%),the difference was statistically significant(P<0.05).5 After 6 months of follow-up,the number of patients with angina,heart failure,nonfatal myocardial infarction and death in the pro-UK group were 2(4.5%),1(2.3%),1(2.3%)and 1(2.3%).The number of patients with angina,heart failure,non fatal myocardial infarction and death in the Tirofiban group were 3(6.5%),3(6.5%),0 and 1(1.2%).There was no significant difference between the two groups(P>0.05).The Composite MACE events in the pro-UK group and the Tirofiban group were 4(9.1%)and 7(15.2%),respectively,and the difference was not statistically significant(P>0.05).6 During the perioperative period,no massive hemorrhage occurred in all the patients.2(4.5%)of the pro-UK group had gingival infiltration and hemostasis after treatment.3(6.5%)of the Tirofiban group had skin bleeding points and black stool respectively.The difference was not statistically significant(P> 0.05).Conclusions High thrombus burden of STEMI patients in PCI were highly selective thrombosis after primary distal injection of rhpro-UK combined with thrombus aspiration:1 It can further increase the level of myocardial perfusion,reduce the incidence of no reflow,improve myocardial perfusion,reduce the area of myocardial infarction and improve the function of left ventricular ejection.2 It has higher safety and less impact on fibrinolytic system,and does not increase the incidence of cardiovascular MACEs events and bleeding events.