Effect Of PCI Timing On Short-term Prognosis Of Patients With Acute Myocardial Infarction After Thrombolysis

Objective:The purpose of this study was to observe the short-term prognosis of patients with acute ST segment elevation myocardial infarction(STEMI)after different timing of PCI.Methods:This study retrospectively analyzed 127 patients with acute ST segment elevation myocardial infarction who underwent percutaneous coronary intervention(PCI)after thrombolysis and recanalization in the Department of Cardiology,Second Hospital of Hebei Medical University from January 2018 to August 2020.The early routine PCI group was set as group A(N=41,2-24 hours after thrombolysis),the selective PCI group was divided into group B(N=50,1-7 days after thrombolysis)and group C(N=36,more than 7 days after thrombolysis).Baseline data,TIMI blood flow classification,corrected TIMI blood flow frames(CTFC),TIMI myocardial perfusion classification(TMPG),no reflow rate(NRP),troponin value and cardiac function before and after PCI were collected.The patients were followed up after 30 days to observe the effect of intervention at different times on major adverse cardiac events(MACE).Results:There was no significant difference in baseline data,medical intervention,preoperative TIMI and TMPG among the three groups(P>0.05).CTFC in early routine PCI group was significantly higher than that in selective PCI group((22.2±1.4)frames vs(21.2±1.9)frames,P=0.001);the incidence of no reflow was significantly higher than that in selective PCI group(12(29.3%)vs 9(10.5%),P=0.008);TIMI and TMPG were significantly higher after PCI(P<0.05);the change rate of troponin before and after PCI was(209±15)%vs(121±13)%,P=0.032).Compared with group B and group C,the intervention time of the two groups was significantly different((5.0±1.0)days vs(8.8±1.6)days,P<0.001);there was no significant difference in the related indexes of no reflow.Compared with group B,CTFC in group A was(22.2±1.4)frames vs(21.3±2.1)frames,P=0.024;the incidence of no reflow was significantly increased(12(29.3%)vs 6(12%),P=0.040);TIMI and TMPG were significantly increased after operation(P<0.05).Compared with group C,CTFC in group A was(22.2±1.4)frames vs(21.1±1.6)frames,P=0.001;the incidence of no reflow was significantly increased(12(29.3%)vs 3(8.3%),P=0.021);TIMI and TMPG were significantly increased(P<0.05).There was no significant difference in left ventricular ejection fraction(LVEF)and left ventricular end diastolic diameter(LV)at 1 month follow-up,and there was no significant difference in MACE incidence during follow-up(χ~2=3.732,P=0.880).Conclusions:In patients with STEMI after thrombolytic recanalization,elective PCI longer than 5 days can further reduce no reflow and improve myocardial perfusion.