Selection Of Early Reperfusion Strategies In Patients With Acute ST-segment Elevation Myocardial Infarction

Objective: To compare the efficacy and prognosis of different early reperfusion methods,and to explore the strategy selection of early reperfusion therapy for patients with acute ST-segment elevation myocardial infarction in Hebei province.Methods:1371 STEMI patients treated in the emergency department from January 2016 to December 2016 in 49 hospitals in Hebei province(including 32 tertiary hospitals and 17 representative secondary hospitals)were included,300 of whom chose thrombolytic therapy as the ITT group,and 1071 of whom chose PPCI treatment as the PPCI group.The baseline data,efficacy and prognosis of the two groups were compared,and the differences in efficacy and prognosis of ITT and PPCI at different starting times of reperfusion(FMC2N ≤ 30 min,FMC2N > 30 min,F MC2 B ≤ 120 min,FMC2B > 120min)were studied.Results:1.By comparing the baseline data of the ITT group and the PPCI group,it was found that the high-risk age of STEMI was about 60 years old,and the majority was male.There was no statistical difference in age,gender,previous medical history and myocardial infarction site between the two groups.2.By comparing the time from the first medical contact to the start of reperfusion(FMC2N and FMC2B),the median FMC2 N time in the ITT group was 63min(38min-95min),the median FMC2 B time in the PPCI group was 95min(60min-150min),and the start time of reperfusion in the ITT group was shorter than that in the PPCI group(P < 0.05),but significantly longer than the standard time.3.By comparing the efficacy and prognosis of the two groups,the vascular recanalization rate of the PPCI group was higher(P < 0.05)and the inpatient mortality rate was lower(P < 0.05)than that of the ITT group.The results were statistically significant.4.By comparing the efficacy and prognosis of the two groups at different starting time of reperfusion,compared with the FMC2 B ≤ 120 min group and the FMC2 B > 120 min group,the FMC2 N > 30 min had a lower vascular reconnection rate and a higher in-hospital mortality,the results were statistically significant(P < 0.05),while the 1-year and 3-year mortality rates showed no statistical difference.Compared with the FMC2 N ≤ 30 min group,the FMC2 B ≤ 120 min group and the FMC2 B > 120 min group,there was no significant statistical difference in the above observation indicators.Conclusions:For STEMI patients within 12 hours of onset,PPCI is preferred to open infarction-related arteries to reduce mortality.If medical conditions are limited,thrombolytic treatment as early as possible(recommended within 30 minutes of first medical contact)is also the best choice.