Effects Of Prourokinase Thrombolysis Combined With Half-dose Tirofiban On Myocardial Microcirculation Reperfusion After PCI In Patients With Acute STEMI Multi-vessel Disease

Objective: To investigate the effect of prourokinase thrombolysis combined with half-dose tirofiban on myocardial microcirculation reperfusion after percutaneous coronary intervention in patients with acute ST segment elevation myocardial infarction multi-vessel diseaseMethods: From September 2018 to September 2020,61 patients with STEMI multi-vessel disease diagnosed by coronary angiography in the Fifth Cardiac Department of the second Hospital of Hebei Medical University were selected as the study subjects.All the patients received prourokinase thrombolysis within 6 hours and percutaneous coronary intervention within 24 hours.All patients were treated with prourokinase 50 mg thrombolysis.The selected patients were divided into study group(n = 36)and control group(n =25)according to whether tirofiban was used before operation.After obtaining the informed consent of the patients’ families,the study group was given tirofiban hydrochloride 12.5 μ g / kg intravenously into 3min,followed by0.075 μ g /(kg.min)to maintain the pump point for 24-36 hours,while the observation group did not give tirofiban pump point.The basic medication of the two groups: the pump point of unfractionated heparin was maintained for about 24 hours,and the dosage of ACT was adjusted according to the maintenance of ACT in 250-300 s.After stopping the use of unfractionated heparin,low molecular weight heparin 70-80iu/Kg was injected subcutaneously for 2 days.Other basic oral drugs included antiplatelet therapy,statins,β-receptor blockers,angiotensin converting enzyme inhibitors /angiotensin receptor antagonists,nitrates and so on.Collect the basic clinical data of the two groups of inpatients(sex,age,body weight,blood pressure,heart rate,markers of myocardial injury,risk factors of coronary heart disease and related medical history,etc.).The infarct-related vascular recanalization,myocardial perfusion(TIMI grade,CTFC,TMPG),cardiac function,myocardial infarct size,incidence of bleeding and other complications were observed after percutaneous coronary intervention,as well as cardiac function1 month after operation,the incidence of major cardiovascular adverse events(including heart failure,malignant arrhythmia,cardiogenic death,Acute or subacute thrombosis,etc.).All the data were analyzed by SPSS 25.0 statistics,and the difference was statistically significant.Results: A total of 61 patients were enrolled in this study,including 36 patients in the study group and 25 patients in the control group.There was no significant difference in baseline data between the two groups in terms of sex,body weight,age,basic medication,underlying diseases,Killip grade of cardiac function,levels of hemoglobin and serum creatinine,CRUSADE score and GRACE score.There was no significant difference in(IRA)distribution,infarction location and SYNTAX score between the two groups(all P > 0.05).There was no significant difference between the study group and the control group in preoperative TIMI blood flow classification status and TMPG classification(P>0.05).Compared with the control group,the thrombus load score(3.0(2,4.5)vs.4(3,5),P<0.05)of the study group was significantly reduced.There was no significant difference in the proportion of TIMI grade 3blood flow between the two groups(P>0.05),but the proportion of grade 3TMPG in the study group(86.1% vs.64%,P=0.043)was significantly higher than that of the control group,and the CTFC count(23.93±3.20 vs.27.20±6.02,P<0.05)was significantly lower than the control group.There was no significant difference in the proportion of no-reflow between the two groups(P>0.05).There was no significant difference in the length and diameter of the stents between the two groups(P>0.05).Comparing the LVEF and LVEDD of the two groups of patients 1 day and 1 month after the operation,there was no statistical difference between the study group and the control group(both P>0.05),and the study group had a trend of improvement compared with the control group at 1 month after the operation..Compared with the control group,the peak values of CK-MB and c Tn I in the study group were significantly reduced(207.19±99.137 vs.271.84±148.418,78.5(67.25,88)vs.93(79.35,98.5),both P<0.05).There was no serious TIMI bleeding in the two groups.There was no significant difference in the incidence of minor bleeding,microbleeding,and forearm swelling in the study group and the control group.There was no significant difference in the incidence of MACEs between the two groups(all P>0.05).Conclusion: : Prourokinase thrombolysis combined with half-dose tirofiban in patients with STEMI multi-vessel disease can reduce the load of coronary thrombus,reduce the area of myocardial infarction,improve the level of myocardial reperfusion,improve the short-term prognosis,and do not significantly increase the risk of bleeding and the incidence of MACEs events.