| Objective: To study the protective effect and prognosis of ischemic postconditioning on reperfusion myocardium in patients with acute ST-segment elevation myocardial infarction treated by direct percutaneous coronary intervention.Methods: From July 2018 to February 2019,58 patients with acute STEMI,who met the PCI criteria and agreed to the study were selected from the Department of Cardiology,First Hospital of Jilin University.After signing the informed consent form,they were numbered in order of visiting time.They were randomly divided into IPost C group and control group.The data of age,sex,hypertension,diabetes,body mass index,smoking history,drinking history,mean arterial pressure at admission,heart rate at admission,onset time,consultation-balloon dilation time,white blood cell count,neutrophil absolute value,absolute value of lymphocyte and platelet,alanine aminotransferase,aspartate aminotransferase,creatinine,uric acid,random blood glucose,low density lipoprotein cholesterol,high density lipoprotein cholesterol,total cholesterol,triglyceride,infarction-related vessels,lesion sites,number of lesion vessels,diameter of stents,length of stents,number of stents,left ventricular end-diastolic diameter,left ventricular ejection fraction,wall motion integral index,application of thrombus aspiration,tirofiban for coronary artery application,drug treatment after operation and so on.There were ST segment drop rate,corrected TIMI grade,TIMI myocardial perfusion grade,intraoperative fatal arrhythmia,preoperative c Tn I and postoperative 6,12,18 hours c Tn I values,postoperative ECG Wagner-selvester scores,left ventricular end-diastolic diameter,left ventricular ejection fraction and wall motion integral index,which were compared between the two groups.Results:1.58 patients were enrolled in this study,including 25 patients in IPost C group and 33 patients in control group.The average age of all patients was(57.09±8.61)years,including 45 males(77.6%).All patients were followed up after 1 month,and no patients were lost.2.The baseline data of two groups were compared: age,sex,hypertension,diabetes,body mass index,smoking history,drinking history,mean arterial pressure at admission,heart rate at admission,onset time,consultation-balloon dilation time,white blood cell count,neutrophil absolute value,absolute value of lymphocyte and platelet,alanine aminotransferase,aspartate aminotransferase,creatinine,uric acid,random blood glucose,low density lipoprotein cholesterol,high density lipoprotein cholesterol,total cholesterol,triglyceride,infarction-related vessels,lesion sites,number of lesion vessels,diameter of stents,length of stents,number of stents,left ventricular end-diastolic diameter,left ventricular ejection fraction,wall motion integral index,application of thrombus aspiration,tirofiban for coronary artery application,drug treatment after operation,which were not significant differences 3.IPost C group compared with the control group,the complete resolution of ST-segment(STR ≥50%)were 88% vs 60.6%,P=0.044;The results of CTFC in the two groups were compared [24(20,32)] vs [32(22,40)],P = 0.022.The difference of TMPG grade 3 between the two groups was 92% vs 66.7%,P = 0.048..4.The fatal arrhythmias in two groups were 12.0% vs 39.4%,P=0.044,which was significant difference.5.Wagner-selvester scores in two groups were [4(3,5)] vs [5(4,6.5)],P=0.010,which was significant difference.6.Echocardiography indicators comparison after 1 months: WMSI in two groups were [1.059(1.000,1.118)] vs [1.118(1.059,1.176)],P=0.047;LVEF in two groups were [59(55,61)]vs[56(52,60)],P=0.026,which were statistically significant difference;and LVDD in two groups was [50(48,52)] vs [50(46,54)],P = 0.699,which were not significant difference.7.The peak value of c Tn I appeared 6 hours after operation in two groups.The peak value of c Tn I in two groups were [68.20(32.75,173.00)] vs [115.00(64.95,215.50)],P=0.138;the area under c Tn I curve were(1332±527.8)vs(1653 ±476.3),P=0.130,and its 95% CI were(297.7-2367)vs(702.6-2567),which were not significant difference.Conclusions: 1.Compared with the control group,IPost C can improve coronary flow velocity and myocardial ischemia perfusion level.2.IPost C can prevent reperfusion arrhythmia in patients with acute AMI.3,IPost C group compared with the control group,can improve left ventricular ejection fraction of the short-term(one months),and can improve local myocardial ischemia.4.It is not clear whether IPost C can reduce the area of myocardial infarction compared with the control group. |
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