| Objective: To compare the effect of primary and delayed percutaneous coronary intervention(PCI)on microcirculation,cardiac function and prognosis among patients with ST-segment elevation myocardial infarction(STEMI)at thrombolysis in myocardial infarction(TIMI)blood flow grade 3.Methods:From March 2019 to January 2020,a total of 112 STEMI patients where selected from the chest pain center of the second hospital of Hebei Medical University all of whom had received emergency coronary angiography(CAG)and randomly divided into the following two groups: the emergency group(n=64)and the delayed group(n=48).The blood flow of the infarct-related artery(IRA)of the both gorups were at TIMI grade 3 and the stenos was no less than 75%.Patients in the emergency group were treated with immediate primary PCI after CAG while in the delayed group,subsequent interventional therapy was performed 7±2 days after CAG.The patients' baseline data,operation related indexes,cardiac function of 1 month after interventional therapy,major advers cardiac and cerebrovascular events(MACCE)and other indicators during hospital stay and discharge within 3 months were reviewed and analysed for the outcomes of independent risk factor.All data were processed by SPSS22.0 software and a value of P <0.05 was considered as statistically significant.Results:(1)A total of 112 patients were included in our study among which 64(57.14%)patients were in emengency group and 40(42.86%)patients were in delayed group.The CAG in the delayed group revealed that the IRA stenosis degree of 8 patients was?75% which means they could avoid stent placement.(2)There were no significant differences in terms of age,gender,smoking,drinking,family history of coronary heart disease,hypertension,diabetes,stroke,systolic blood pressure,diastolic blood pressure,heart rate,serum creatinine,basic medication,time to first medical contact,IRA composition and stent placement quantity between the two groups,(P> 0.05).(3)No significant differences were detected in the TIMI blood flow after IRA intervention,CTFC after the first CAG,and the incidence of postoperative IRA no reflow/slow blood flow between the two groups(P> 0.05).However,after the IRA interventional treatment,the proportion of preoperative TIMI blood flow at grade 3 in the delayed group tended to be higher than that in the emergency group(97.9% vs.95.3%,P= 0.464).Besides,both the incidence of postoperative IRA no reflow/slow blood flow and CTFC after IRA intervention in the emergency group were significantly higher than the delayed group with P= 0.464 and P< 0.001 respectively.In the emergency group,the CTFC after interventional therapy was higher than that before interventional therapy[29.69 ± 7.22 frames vs.24.84 ± 4.56 frames,P< 0.001].In the delayed group,the CTFC before interventional therapy was lower than that after the first CAG [23.94 ± 3.63 frames vs.25.90 ± 3.45 frames,P< 0.001].There was no significant difference in terms of CTFC before and after interventional treatment in the delayed group,P> 0.05.(4)The left ventricular ejection fraction(LVEF)in the emergency group was lower than that in the delayed group [46.32(42.84,50.17)% vs.49.81(44.79,54.88)%,P= 0.02].The left ventricular enddiastolic dimension(LVEDD)in the emergency group was larger than that in the delayed group[(54.11±3.33)mm vs.(51.70±3.30)mm,P< 0.001].There were no significant difference in the E/A,the E/e ? and the peak of cardiac troponin I(c Tn I)between the two groups of patients.While the E/A in the delayed group tended to be higher than that in the primary group [0.89(0.65,1.21)vs.0.77(0.65,0.99),P= 0.128].The E/e ? in the primary group tended to be higher than that in the delayed group [(13.61 ± 4.30)vs.(12.20 ± 3.34),P= 0.066].The peak of c Tn I in the delayed group tended to be lower than that in the emergency group [75.80(44.70,101.00)U/L vs.97.50(27.60,101.00)U/L,P= 0.568].The peak of CK in the emergency group was higher than that in the delayed group [2126.69 ± 1653.43 U/L vs.1588.27 ± 1050.34 U/L,P= 0.038].The peak of CK-MB in the emergency group was higher than that in the delayed group [242.96 ± 188.82 U/L vs.184.5 ± 116.67 U/L,P= 0.046].There was no significant difference in the value of BNP of 24 hours after interventional therapy between the two groups of patients,but the BNP in the delayed group tended to be lower than that in the emergency group [59.00(37.75,151.50)pg/ml vs.74.70(34.18,244.50)pg/ml,P= 0.404].(5)There was no significant difference in the incidence of recurrent myocardial infarction,cerebral hemorrhage and other bleeding events between the two groups of patients during hospitalization,P> 0.05.There was no significant difference in the incidence of MACE events between the two groups of patients during hospitalization and within 3 months of out-of-hospital following-up,P> 0.05.Conclusions:For STEMI patients with a patent IRA,the delayed PCI group under adequately antithrombotic and anticoagulant treatment can reduce reperfusion injury and protect coronary microcirculation.Delayed PCI is superior to emergency PCI in reducing postoperative incidence of no reflow/ slow blood flow and improving cardiac function and near-term prognosis of STEMI patients,without increasing in-hospital MACE and mortality. |
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