| Objective:By comparing with primary emergency percutaneous coronary intervention（PCI）,I discussed the protective effect of thrombolytic therapy combined with early PCI after thrombolysis in early reperfusion therapy of acute ST-segment elevation myocardial infarction（STEMI）.To provide effective and safe basis for thrombolytic therapy combined with PCI in early STEMI reperfusio.Methods:Consecutive cases of STEMI received emergency PCI in five departments of Cardiovascular Department of the second Hospital of Hebei Medical University and inspected rest 99mTc-MIBI-SPECT myocardial imaging 7 days after operation were enrolled from October 2016 to December2017.According to whether the patients received intravenous thrombolytic therapy,the eligible patients were divided into two groups:Post-Thromolysis PCI group（T-PCI group）and Primary PCI group（P-PCI group）,according to the results of CAG,PCI was performed unless the blood flow of IRA not achieves TIMI flow grade 3 or achieved TIMI flow grade 3 with significant stenosis more than 75%.According to the patients’condition.After admission,all detail were recorded,including general baseline information,operative data,such as reperfusion time,TIMI flow of IRA before and after PCI,thrombus score and coronary microcirculation related indicators:CTFC、TMPG were analyzed.Both groups measured LVEF by taking echocardiography 2-3 days after PCI and myocardial infarct size（MIS）by 99mTc-MIBI-SPECT 7 days after PCI.All the patient were Reexaminated of echocardiography 3 months after PCI.All patients were followed up for 3 months to assess bleeding implications and major adverse cardiac events（MACEs）.SPSS 21.0 for Windows was used for statistical analysis.Values of P<0.05 were considered statistically significant.Results:A total of 61 cases were enrolled with 23 cases in T-PCI group and 38cases in P-PCI group.All patients in T-PCI group were transferred from primary medical institutions.Among all the patients,32 patients with IRA were LAD,21 patients were RCA and 8 patients were LCX.General baseline information were similar between the two groups（all P>0.05）.In terms of myocardial necrosis marker enzymesthe,the peal value of CK-MB in T-PCI group higher than P-PCI group,while there was no statistical significance between two groups;and the peal value of cTn I in T-PCI group higher than P-PCI group,and there was a significant difference（100.0（54）vs.78.72（77）,P=0.031）.The onset time of reperfusion in T-PCI group（Onset to start thrombolysis）was significantly shorter than that in P-PCI group（onset to CAG）,and the difference was significant（2.92±0.79h vs.5.51±1.96h,P=0.002）.The total ischemic time（Time from onset to recanalization or/and IRA recovery）of T-PCI group was significantly shorter than that of P-PCI group,and the difference was statistically significant（4.00（4.50）h vs.6.50（3.10）h,P=0.006）.The CAG of the two groups showed that there was significant difference in the blood flow ratio of TIMI grade 0 and grade 3 between the two groups before TIMI（26.1%vs.63.2%,P<0.005;43.5%vs.5.3%,P<0.001）.There was no significant difference in blood flow between grade 2 and grade 3 after PCI（17.4%vs.21.1%,P=0.730;82.6%vs.78.6%,P=0.730）.For thrombus integral,there was a difference between the two groups when the thrombus score was 5 points（26.1%vs.63.2%,P<0.05）.The level of CTFC in T-PCI group after PCI was higher than that in P-PCI group,which was statistically significant（22（6）vs.24.9（9.9）,P=0.021）.The ratio of postoperative myocardial perfusion with TMPG grade 3 in T-PCI group was significantly higher than that in P-PCI group,and the difference was statistically significant（82.6%vs.57.9%,P=0.048）.The results showed that LVEF in T-PCI group was slightly higher than that in P-PCI group（53.95±10.92%vs.53.83±6.59%,P=0.04）.At 3 months after operation,there was no difference in LVEF between the two groups（55.44±7.69%vs.55.02±9.50%,P=0.494）.There was no significant difference between T-PCI group（53.95±10.92%vs.55.44±7.69%,P=0.346）and P-PCI group（53.83±6.59%vs.55.02±9.50%,P=0.206）.After 7 days of operation,the patients in both groups were examined by rest 99mTc-MIBI-SPECT myocardial imaging.The results showed that the percentage of MIS in total left ventricular area in T-PCI group was lower than that in P-PCI group,but the difference was not statistically significant（18.09±5.60%vs.21.24±5.7%,P=0.736）;The percentage of myocardial infarction area in the infarct-related artery innervation area in T-PCI group had decreasing trend compared with that in P-PCI group,the difference was not statistically significant（LAD:34.54±11.14%vs.40.47±11.80%,P=0.354;RCA:39.38±19.18%vs.53.00±12.24%,P=0.250;LCX:34.00±2.82%vs.43.50±15.63%,P=0.077）.Major bleeding occurred 1 case in both groups,Minor bleeding occurred4 cases in T-PCI group and 5 cases in P-PCI group.There was no significant difference between the two groups.One patient in P-PCI group received in-hospital transfusion therapy.MACEs events in 3 months were recorded in the two groups.There was no significant difference in the incidence of MACEs between the two groups（P>0.05）.Conclution:1.Compared with pPCI,thrombolytic therapy combined with PCI can improve myocardial perfusion.2.Thrombolytic combined with PCI can play a better role in myocardial protection in the acute phase of STEMI,without increasing the risk of bleeding complications and the MACEs incidence. |
