Correlation Study Of Prodromal Angina Pectoris In Patients With Acute ST-segment Elevation Myocardial Infarction And Slow Blood Flow After Emergency PCI

Part Ⅰ The effect of angina before infarction on the prognosis of patients with acute STEMI and slow blood flow after emergency PCIObjective To observe whether prodromal angina pectoris protects patients with acute ST-segment elevation myocardial infarction in short-term prognosis after emergency PCI,major adverse cardiovascular events,and slow blood flow.Methods Using retrospective analysis,633 patients with ST-segment elevation myocardial infarction of South Campus of the Sixth People’s Hospital Affiliated to Shanghai Jiaotong University were collected and the patients were divided into the PAP groups and the non-PAP groups according to the presence or absence of PAP.PCIs were performed in the emergency catheterization room,and the patient’s TIMI grade,postoperative cTFC(corrected TIMI frame count),number of diseased vessels,and the presence or absence of CSF were recorded.Postoperative patient’s cTn-I,BNP,LVEF,SUM-STR(ST segment fall rate)and various MACEs were recorded and analyzed.Results The number of cases of malignant arrhythmia such as ventricular tachycardia,ventricular fibrillation,Ⅲ°-AVB(Ⅲ degree atrioventricular block)and postoperative angina pectoris and death were lower in the PAP group than in the non-PAP group(P<0.05).Intraoperative TIMI blood flow classification,cTFC,CSF,collateral circulation the PAP group were better than the non-PAP group(P<0.05).The cTn-I,creatine kinase isoenzyme,myoglobin,BNP peak concentration in the PAP group were less than the non-PAP group(P<0.05),the LVEF values the PAP group were better than the non-PAP group(P<0.05).The PAP was associated with the occurrence of CSF during emergency PCI(OR=0.185,95%C.L.=0.074-0.462,P=0.000).Conclusion The PAP has an important protective effect on the short-term prognosis of STEMI patients and the occurrence of MACE,and reduces the incidence of CSF during emergency PCI,ensuring effective myocardial perfusion,limit the area of myocardial infarction,down-regulate the peak value of myocardial necrosis markers,and it has crucial predictive value for clinical treatment to judge the prognosis of STEMI patients and successful revascularization(PCI or thrombolysis),and it is of great guiding role for clinical medical staff to evaluate the condition of STEMI patients,and PAP should attract enough attention.Figure[1]table[13]reference[102].Part 2 The effect of thrombus aspiration combined with microcatheter targeted application of recombinant human prourokinase on myocardial blood perfusion in patients with ST elevation acute myocardial infarctionObjective To investigate whether selective application of thrombolytic drug recombinant human urokinase on the basis of thrombus aspiration can improve myocardial blood perfusion and prognosis in patients with ST-segment elevation myocardial infarction undergoing emergency PCI.Methods Using retrospective analysis,STEMI patients who underwent emergency PCI in the cardiology department were selected.After intraoperative thrombectomy and before stent implantation,according to recombinant human urokinase or timofiban was injected by microcatheter targeting,STEMI patients are divided into experimental group(n=55)and control group(n=55),and immediately after operation,the patient’s TIMI grade,cTFC(corrected TIMI frame count),SUM-STR(ST segment fall rate)were evaluated,and follow-up records were made on the patient’s general data and serum troponin-I,BNP,and left ventricular ejection fraction(LVEF),major adverse cardiovascular events(MACE)and bleeding,etc.Results The TIMI level and LVEF value of the two groups after drug intervention in the recombinant human urokinase group were significantly higher than those in the tirofiban group(P<0.05),and the occurrence of slow blood flow and MACE in the recombinant human urokinase group were significantly less than those in the tirofiban group number(P<0.05).The cTFC,troponin-I,BNP peak concentration in the recombinant human urokinase group was significantly smaller than the tirofiban group(P<0.05),and the SUM-STR>70%recombinant human urokinase group was more than the tirofiban group(P<0.05).In terms of minor bleeding and microbleeding,the number of cases of recombinant human urokinase was significantly less than that of the tirofiban group(P<0.05).Conclusion Thrombus aspiration combined with microcatheter targeted application of recombinant human urokinase can significantly improve myocardial blood perfusion and prognosis in patients with STEMI,and it has fewer bleeding side effects and a higher safety factor,updated the traditional "simple PCI" solution,which is worthy of vigorous promotion in the clinic.