| BackgroundAt present,there is a consensus in academic circles that most of the infar-ct related artery(IRA)in patients with acute non-ST segment elevation myocardi-al infarction(NSTEMI)are non-occlusive,and the main type of thrombus is white thrombus rich in platelets.thrombolytic therapy not only can not ben-efit these patients,but will activate the blood coagulation system,making the unst-able plaque more unstable and leading to intra-plaque bleeding.There is no doubt that there are two kinds of objective reality in NSTEMI: ST segment depression and ST segment unoffset.The previous work of our group found that there were differences in thrombus types and coronary angio-graphic characteristics between the two groups.According to the changes of ST segment on admission,acute NSTEMI should be divided into two clinical types: acute ST segment unoffset myocardial infarction(STUMI)and acute ST segment depression myocardial infarction(STDMI).Preliminary studies have shown that STUMI is mostly caused by single vessel occlusive disease,and its thrombus type is mainly red thrombus or mixed thrombus.If so,whether such patients can benefit from thrombolytic therapy has become a scientific question worth exploringIntracoronary thrombolytic therapy has shown the advantages of local and low-dose drugs in reducing the risk of bleeding,effectively opening coronary artery power vessels and protecting microcirculation in a large number of clinical practices.ObjectiveThe purpose of this study was to investigate the safety and efficacy of intracoronary thrombolysis in patients with STUMI.Methods94 patients with acute ST segment unshifted myocardial infarction who underwent coronary angiography indirectly in Henan people’s Hospital from June 2019 to February 2021 were enrolled in this study.The angiographic findings showed that the TIMI grade of thrombus was ≥ 3.The patients were randomly divided into two groups: intracoronary thrombolysis + percutaneous coronary intervention group and primary percutaneous coronary intervention group.Collect relevant data,including baseline data: age,sex,smoking history,drinking history,hypertension history,diabetes history,dyslipidemia,body mass index,left ventricular ejection fraction,Killip grade;coronary angiography data: infarct related vessels(IRA),number of diseased vessels,thrombus TIMI grade,blood flow TIMI grade,myocardial color grade(MBG).Degree of myocardial injury: creatine kinase(CK),creatine kinase isoenzyme(CK-MB),troponin I(c Tn I).Statistical methods were used to compare the infarct-related vascular perfusion,myocardial perfusion,the incedence of MACE occurrence and bleeding complications between the two groups after preconditioning.Result1.There was no significant difference in baseline data between the throm-bolysis group and the control group.2.There was no significant difference in initial coronary angiography data(infarction related vessels,number of diseased vessels,thrombus TIMI grade,blood flow TIMI grade)between the two groups.3.Results of coronary angiography after PCI:(1)The TIMI blood flow ≥ 2 grade before balloon dilatation in thrombolysis group and control group were 26 cases(55.32%)and 1 cases(2.13%)respectively.There was significant difference between the two groups(P < 0.05).(2)The number of stent implantation in thrombolysis group and control group was 37(78.72%)and 45(95.74%)respectively,and there was significant difference between the two groups(P < 0.05).(3)After PCI,TIMI2 grade was found in 4 cases(8.51%)in thrombolysis group and 9 cases(19.15%)in control group,and TIMI3 grade was 43 cases(91.49%)and 38 cases(80.85%)in thrombolysis group and control group respectively.4.The myocardial color grades of grade 1,grade 2,grade 3 and grade 3 in thrombolysis group and control group were 3(6.38%),12(25.53%),9(19.15%),17(36.17%),36(76.60%)and 18(38.30%),respectively.The difference was statistically significant(P < 0.05).5.The peak values of CK(1272.30 ±401.43 U / L),CK-MB(116.11 ±40.11 IU / L)and III Tn I(33.36 ±12.45 ng/ml)in the thrombolysis group were significantly higher than those in the control group(CK(1458.57 ±304.76 U / L),CK-MB(168.00 ±56.89 U / L)and Tn I(59.70 ±16.69 U / L).The difference was statistically significant(P < 0.05).6.The total MACE events during hospitalization in thrombolysis group and control group were 8 cases(17.02%)and 11 cases(24.40%),respectively,including malignant arrhythmias in 8 cases(17.02%)and 11 cases(23.40%),heart failure in 3 cases(6.38%)and 4 cases(8.51%),cardiac arrest in 2 cases(4.26%)and 1 case(2.13%),and cardiac death in 1 case(2.13%).There was no significant difference between the two groups(P > 0.05).7.The bleeding complications of thrombolysis group and control group: cerebral hemorrhage,gastrointestinal hemorrhage,hemoptysis and puncture site hematoma did not occur in both groups.Skin and mucous membrane bleeding was found in 2 cases(4.26%)and 1 case(2.13%),gingival bleeding in 6 cases(12.77%)and 7 cases(14.89%)respectively.There was no significant difference between the two groups(P > 0.05).Conclusion1.Intracoronary thrombolytic therapy in patients with STUMI is safe and effective. |
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