Curative Effect Of Prourokinase Or Tirofiban Combined With Primary Coronary Intervention In The Treatment Of Acute ST-segment Elevation Myocardial Infarction

Objective:To investigate the impact ofmyocardial tissue perfusionin patients with highthromboticloadacute STEMI during PPCI treatmentprocess with intracoronary Prourokinase or tirofiban injection into the infarction related artery by the guided catheter,and observation the impact of patients with cardiac function index,bleeding events and the incidence of major adverse cardiovascular events.Methods: From January 2017 to June 2019,70 STEMI patients with high thrombotic load who received PPCI treatment within 12 hours after onset were divided into two groups: Group A and Group B.There were 46 males and 24 females,with an average age of(60.2±9.9)years old.In group A,a total of 31 patients received 20 mg of Prourokinase injected into the infarct-related artery via theguided catheter during PPCI.A total of 39 patients in group B received 1mg oftirofeben injected into the infarct-related artery via the guided catheter.A retrospective case-control study was conducted.Patients in both groups were given aspirin 300 mg,Tegriluo 180 mg,Atorvastatin 80 mg before surgery.Blood was taken to measure the basic ACT value and heparin calcium injection was given at 100IU/kg.After balloon expansion in group A patients,lesion vessel,20 mg Prourokinase with 10 ml physiological saline was slowly injected into the infarct-related artery via the guided catheter(about 5 minutes),after balloon expansion in group B patients,lesion vessel,1 mgtirofeben was slowly injected into the infarct-related artery via the guided catheter(about 5 minutes).Coronary angiography was then repeated in both groups,followed by routine PCI,and post-balloon dilatation was determined based on stent placementand Review coronary angiography after PCI.CTFC,TMPG and sum STR were compared between the two groups to reflect the coronary microcirculation perfusion of the patients.The left ventricular end-diastolic diameter and ejection fraction of echocardiography were compared 7 days and 1 month postoperatively to reflect cardiac function.The incidence of major adverse cardiovascular events and bleeding were compared during hospitalization and 1 month after surgery.Results :(1)There were no statistically significant differences in age,sex,smoking history,hypertension,diabetes,hyperlipidemia,Killip grade ≥2,or family history of coronary heart disease between the two groups(P>0.05).(2)Comparison of PCI between the two groups: there were no statistically significant differences in the number of infarct-related arteries,thrombus catheter aspiration and stent implantation between the two groups(P>0.05).(3)Comparison of target vascular perfusion and myocardial perfusion levels between the two groups: there was no statistically significant difference in c TFC between the two groups before surgery(P>0.05),and there was A statistically significant difference in c TFC between the two groups after surgery(P<0.05).CTFC in group A was lower than that in group B.CTFC in group A were significantly different before and after treatment(P<0.05).CTFC values in group B were significantly different before and after treatment(P<0.05).There were statistically significant differences between the two groups of patients with TMPG≥2 after operation(P<0.05).There were statistically significant differences between the two groups in patients with sum STR≥30%(P<0.05).All the data suggested that group A had better coronary microcirculation perfusion level than group B.(4)Comparison of cardiac echocardiography,major cardiovascular adverse events and bleeding events between the two groups during hospitalization: During hospitalization,there was no statistically significant difference in LVEDD and LVEF between the two groups(P>0.05).There was no significant difference in the incidence of major cardiovascular adverse events(P>0.05).Three patients in group A and four patients in group B suffered from minor bleeding.Comparison between the two groups has no statistical significance(P=0.748).(5)Comparison of cardiac echocardiography,major cardiovascular adverse events and bleeding events between the two groups after 1 month of postoperative follow-up: There were statistically significant differences in LVEDD and LVEF between the two groups(P<0.05),and group A was better than group B.There was no significant difference in the incidence of major cardiovascular adverse events between group A and group B(P>0.05).One person in group A and one person in group B had mild bleeding.Comparison between the two groups has no statistical significance(P=0.577).Conclusion: Myocardial microcirculation reperfusion can be improved in patients with STEMI during PPCI treatment process by intracoronary Prourokinase or tirofiban injection into the infarction related artery by the guided catheter.Prourokinase obtained better myocardial microperfusion than tirofeben,improved left end-diastolic volume and cardiac function 1 month after surgery,and did not increase the incidence of major cardiovascular adverse events and bleeding events.