| Objective: This study was aimed to compare the influence of percutaneous coronary intervention (PCI) on artery repatency, myocardial reperfusion, ventricular systolic and diastolic function, bleeding complications, the incidence of major adverse cardiac events (MACE), in-hospital stay and charges between early PCI (about 6 hours) and elective PCI after thrombolysis with reteplase in patients with ST elevation acute myocardial infarction (STEMI), and to probe the clinical effect, safety, economic benefit and cost of early PCI after thrombolysis with reteplase in the treatment of STEMI.Methods: Patients with STEMI who admitted in our hospital from June 2009 to December 2010 were included in this study. All the cases were diagnosed according to the criteria of WHO for STEMI and without the contraindication of thrombolysis. A dose of 300mg clopidogrel and 300mg aspirin was administered immediately after the diagnosis of STEMI to all the patients. The Reteplase was used for thrombolysis, which was injected 10MU twice at interval of 30 minutes intravenously. A total of 71 patients whose symptom and electric cardiogram indicated the sign of repatency with residual stenosis of IRA >75% was divided into early PCI group (32 cases) and elective PCI group (39cases). PCI was respectively performed 6 hours after thrombolysis in early PCI group and 7 to 10 days after onset of AMI in elective PCI group. A loading dose of 10ug/kg of tirofiban was injected intravenously within 3 minutes during PCI, followed by a dose of 0.15ug/kg/min of tirofiban was intravenously infusion for 24 hours. A dose of 5000U heparin was injected through artery sheath, which was added 3000U every 1 hour during PCI, and active clotting time (ACT) was monitored. Low molecular weight heparin (LMWH) was subcutaneously injected every 12 hours, clopidogrel 75mg/day and aspirin 300mg/day were administered post PCI to all the patients. Agents such as ACEI,β-blocker, statin and nitroglycerin were used in all the patients if there was no contraindication. The clinical data of patients in the two groups were recorded to compare the baseline condition including age, sex, risk factors, pre-infarction angina, location of infarction and cardiac function classification. The coronary lesion was measured by quantitative coronary analysis system, and the rate of coronary repatency, stenosis degree of coronary,thrombolysis in myocardial infarction flow grade pre-PCI and post-PCI, as well the TIMI myocardial perfusion grading (TMPG) were compared between the two groups. Echocardiography was performed 1 week and 3 months after onset of AMI respectively to evaluate the left ventricular function. The major adverse cardiac events (MACE), including cardiac death, serious heart failure, myocardial reinfarction, malignant arrhythmias and reconstruction of target vessels in hospital after AMI were followed up and compared between the two groups. The in-hospital stay and charges were calculated and compared between the two groups. All the data were analyzed with SPSS software (version 13.0), continuous variables were presented with means±standard deviation and compared between groups with the use of Student's T-test. Categorical variables were presented with percent and compared between groups with the use of Chi-square tests or Fishers exact probability. Wilcoxon rank tests for the numerical variable data of the nonnormal distribution. A P-value of less than 0.05 was considered to be statistically significant.Results: There were no statistic significances between the two groups in sex, age, risk factor of coronary heart disease (hypertension, dyslipidemia, smoking and drinking history), pre-infarction angina, infarction location, and IRA distributions.There were no significant differences in TIMI flow grade before PCI between the two group (TIMI flow grade 1, 1 case (3.1%) vs. 4 cases(10.3%),TIMI flow grade 2, 7 cases(21.9%) vs. 15cases(38.5%),TIMI flow grade 3, 24 cases(75%) vs. 20cases (51.3%), all P>0.05). The repatency rate of IRA (TIMI flow grade 2 and 3) before PCI in early PCI group was 96.9%, while it was 89.5% in elective PCI group (P>0.05). The complete repatency rate (TIMI flow grade 3) in early PCI group was higher than that in elective PCI group (75.0% vs. 51.3%, P<0.05). The rate of TIMI flow grade 2 post PCI was 3.1%, while it was 7.7% in elective group (P>0.05). No differences were found in the rate of TIMI flow grade 3 and the rate of TMPG above 2 post PCI (both P>0.05).The value of LVEDVI, LVESVI and LVEF in early PCI group at 1 week after AMI was no significant difference compared with that in elective PCI group(73.43±20.80vs.78.44±20.67, 35.79±13.04 vs. 40.64±16.87, 51.72±7.04 vs. 49.70±8.50, all P>0.05). Though the values of LVEDVI, LVESVI and LVEF 3 months after PCI were not significantly different between the two groups (55.98±11.68 vs. 65.43±13.17, 21.33±6.20 vs. 25.89±9.46, 61.82±7.02 vs. 61.07±8.32, all P>0.05), the value of LVEDVI and LVESVI 3 months after AMI was significantly decreased compared with that 1 week after AMI in early PCI group (73.43±20.80 vs. 55.98±11.68, 35.79±13.04 vs. 21.33±6.20, both P<0.05), and in elective PCI group (78.44±20.67 vs. 65.43±13.17, 40.64±16.87 vs. 25.89±9.46, both P <0.05). The value of LVEF was obviously increasead 3 months after AMI compared with that 1 week after AMI in early PCI group (51.72±7.04 vs. 61.82±7.02, P<0.05) and in elective PCI group (49.70±8.50 vs. 61.07±8.32,P<0.05).The incidence of MACE was not significantly different between the two groups (malignant arrhythmia 9.4% vs. 7.7%, P>0.05, and severe heart failure 6.3% vs. 10.3%, P>0.05). The incidence of post-infarction angina in early PCI group was lower than that in elective group (3.1% vs. 23.1%, P<0.05).There were no significant difference in the incidence of bleeding complication between the two group, among which the incidence of TIMI mild bleeding was 15.6% vs. 12.8%, and the incidence of radial artery approach bleeding was 6.3% vs. 7.7% (all P >0.05). The in-hospital stay in early PCI group was shorter than that in elective group (10.13±2.89 days vs. 17.28±5.89 days, P<0.05), and the cost was also lower in early PCI group than that in elective group (40888.09±12680.01Yuan, 48013.28±22760.56Yuan, both P<0.05).Conclusions:1 Early PCI after thrombolysis repatency with reteplase in STEMI can improve the coronary blood flow and myocardial perfusion compared with elective PCI.2 Both early PCI and elective PCI after thrombolysis repatency with reteplase in STEMI can improve heart function and inhibit myocardial remodeling.3 Early PCI after thrombolysis repatency with reteplase in STEMI can reduce the incidence of post-infarction angina, but do not increase the incidence of MACE compared with elective PCI.4 Early PCI after thrombolysis repatency with reteplase in STEMI does not increase the incidence of bleeding complications.5 Early PCI after thrombolysis repatency with reteplase in STEMI can decrease the in-hospital stay and cost compared with elective PCI.
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