The Impact Of Ischemic Postconditioning During Primary Percutaneous Coronary Intervention On Short-term Prognosis Of Acute ST-segment Elevation Myocardial Infarction

Objective:To study the impact of ischemic postconditioning during primary percutaneous coronary intervention on short-term prognosis for the patients with acute ST-segment elevation myocardial infarction,by analysis of the hospitalized patients with acute myocardial infarction who treated by primary PCI in the cardiovascular department of the First People's Hospital in Huainan City,to understand whether the method can reduce the myocardial ischemia reperfusion injury and improve the prognosis of patients.Methods: Bring into the hospitalized patients with acute ST-segment elevation myocardial infarction and treated by emergency percutaneous coronary intervention(PCI)in the cardiovascular department of the First People's Hospital in Huainan City from October 2015 to June 2017,recorded the sex and age of patients,hypertension,diabetes and other general data.These patients were divided into two groups by random numbers.The patients treated with PCI alone were the contrast group.The patients in the primary PCI group received ischemic postconditioning(IPost C)as the observation group.The infarct related artery(IRA)was determined according to the results of electrocardiogram combined with coronary angiography(CAG),and only treated IRA.The contrast group using conventional PCI surgery,the observation group ectasyed the balloon quickly at the vascular lesion after the guide wire through the distal vascular occlusion,and keeped the baloon ectasying with the small pressure(4 ~ 6atm)for 30 S,then shrink balloon for 30 s,this process as one cycle,repeated the process at least 3 cycles.Angiography at multiple positions were performed to ensure the successful of PCI.Observation indexes:(1)reperfusion arrhythmia,(2)TIMI blood flow of IRA after PCI,(3)c Tn I,NT-Pro BNP,CRP and CK-MB in serum after PCI.(4)left ventricular ejection fraction(LVEF)for 6 months after PCI,(5)major adverse cardiac events(MACE)for 6 months after PCI.The data were statistically analyzed with SPSS 19 software package,and the results were statistically significant with P<0.05.Results: This study included 96 patients,including 46 cases of ischemic postconditioning group,50 cases in the contrast group,the differences between two groups of age,gender,hypertension,diabetes,smoking rate,was not outstangding,had no statistical significance(P>0.05);the differences between the two groups of infarct related artery(IRA),the total of stents implanted,the cases of intraoperative implanted,was not statistical significance(P>0.05);compared with the contrast group,the post adaptation group was no significant difference in the type and proportion of reperfusion arrhythmia,was not tatistical significance(P>0.05);the differences between the two groups of the target vessels immediately TIMI flow after PCI,was not statistical significance(P>0.05);compared with the contrast group,the difference of c Tn I,NTPro BNP,CRP and CK-MB in serum 24 hours after PCI in the postconditioning group,was statistical significance(P<0.05);the differences between the two groups of NT-Pro BNP in hospitalization during 24 hours after operation was statistically significant(P<0.01);compared with the contrast group,the post adaptation group had significant difference of LVEF after PCI for six months,it was statistically significant(P<0.01),the differences between the two groups of major cardiovascular adverse events(MACE)after PCI for 6 months was not statistical significance(P>0.05).Conclusion: The results of this study show that the ischemic postconditioning method in acute ST segment elevation myocardial infarction during primary PCI can effectively reduce myocardial ischemia reperfusion injury?the infarct size and improve cardiac function.