A Comparative Study Of The Effect Of Different Reperfusion Strategies On Acute Myocardial Infarction

Objective: to compare the effects of different reperfusion strategies in the treatment of ST-segment elevation myocardial infarction(ST-segment elevation myocardial infarction,STEMI)and to explore the feasibility and safety of pharmacoinvasive and joint intervention strategy in patients with STEMI.Methods:From April 2017 to February 2018,a total of 118 patients with STEMI who were admitted to the Chest Pain Center of the second Hospital of Hebei Medical University and received emergency coronary angiography(CAG)were divided into the following three groups according to the reperfusion strategy received: primary percutaneous coronary intervention group(P-PCI group,group A,n=74),early PCI following intravenous thrombolysis(E-PCI group,group B,n=32),and intracoronary thrombolysis combined with PCI(group C,n=12 Cases).Patients in the group A were first diagnosed in o ur hospital within 12 hours of onset of STEMI patients,and they were treated with the routine P-PCI.The patients in group B had been transferred to our hospital for early CAG examination and PCI within 3-24 hours of intravenous thrombolytic therapy within 12 hours before the onset of the disease.The urokinase thrombolytic therapy of 20 mg was given in the coronary artery in the patients whose infarction related artery was with grade IV or more.The coronary blood flow(Thrombolysis in myocardial infarction,TIMI)at grade III,fixed stenosis less than 75% and stable plaque were not treated in emergency stent implantation.Basic data of all the patients were collected and compared among the three groups.The preoperative and postoperative thrombus load scores were compared including TIMI blood flow level and corrected TIMI flowmeter frame(Corrected TIMI Frame Count,CTFC),Cardiac function,peak level of myocardial necrosis markers,level of BNP,stent implantation rate,and major adverse cardiac events(MACE)during hospitalization among the three groups.All the data were processed by SPSS22.0 software and a value of P < 0.05 was defined as statistically significance.Results:A total of 118 patients were enrolled,inc luding 74 cases in group A(62.71%),32 cases of group B(27.12%),12 cases of group C(10.17%).There were significant differences in the duration of symptom-reperfusion therapy between group B and group A as compared with group C(P = 0.001).There was no significant difference in the proportion of multivessel lesions among the three groups(P = 0.208).Before interventional therapy of the three groups,the score of thrombus load in group C was higher than those in group A and group B(P < 0.05).The ratio of grade 3 TIMI blood flow in group B was higher than that in group A before interventional therapy(P=0.018).After interventional therapy of the three groups,The ratio of TIMI blood flow grade 3 in group B was higher than those in group A and group C(P=0.022).The rate of emergency stent implantation in Group A was higher than those in Group B and Group C(P < 0.05).After interventional therapy in three groups,the CTFC in group A was higher than those in group B and C(P=0.004).The of LVEF in group A is lower than that of group B(P=0.04).LVEDD in the group A is higher than that of group B(P=0.008).The of E/A in group B was higher than those in group A and group C(P=0.004).The E / E' in group A was higher than that of group B(P=0.042).The peak value of CK in group C was higher than those in group A and B(P=0.012).The peak value of CK-MB in group C was higher than those in group A and B(P=0.014).Peak level of c TnI in group B were lower than those in group A and group C(P=0.008).The serum BNP in group A was higher than those in group B and C at admission(P=0.001).There was no significant difference in recurrent myocardial infarction and cerebral hemorrhage among the thre e groups(P>0.05).The incidence of bleeding events(except cerebral hemorrhage)during hospitalization in Group A patients was higher than those in Group B and Group C(P=0.043).Conclusion:1.For patients with STEMI,early intravenous thrombolysis could achieve myocardial prefus ion effectively,and could make the coronary flow improved.Intravenous thrombolysis decreases the rate of stent implantation and infarction size,without increase of bleeding complications.2.Intracoronary thrombolysis could improve the coronary flow after PCI,decrease the inc idence of no reflow,protect the heart function of the patient without increase of bleeding complications.