Comparison Of Efficacy And Safety Between Facilitated PCI And Primary PCI On ST-segment Elevation Myocardial Infarction

Background Coronary atherosclerotic heart disease, for short Coronary heart disease (CHD), caused by atherosclerosis in organ lesions,is the most common type but acute myocardial infarction is the most serious one. According to electrocardiogram ST-segment elevation whether or not when patient to fall ill, acute myocardial infarction(AMI)is divided into ST-segment elevation myocardial infarction(STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). A large body of literature indicates, as soon as possible, complete and sustained opening of infarct related artery (infarctrelated artery, IRA) of the blood supply is the key to improve the prognosis of patients with acute myocardial infarction. At present, there are two major open vascular occlusion treatments: drug thrombolytic therapy and primary percutaneous coronary intervention (PCI). But two methods have their advantages and disadvantages. Facilitated PCI is proposed in recent years, this new treatment strategies not only can compensate for the lack of intravenous thrombolysis with low opening, but also to make up for reperfusion time delay defects of primary PCI. Facilitated PCI refers to applying reduction of thrombolytic agents and(or)platelet GpⅡb/Ⅲa receptor blocker before PCI, this therapy is a recently proposed STEMI reperfusion,which may improve the effectiveness of a promising strategy. Thus comparison between facilitated PCI and primary PCI become the focus of clinical research. This study is to compare the short term efficacy and safety between facilitated PCI and primary PCI on STEMI for finding a better method of AMI in matrical territory of our country.Objective This study is made to compare facilitated PCI with primary PCI treatment of STEMI short-term clinical effects and safety in primary hosptals. The purpose of this study is to preliminarily explore the differences in the clinical effects between facilitated PCI and primary PCI in STEMI therapy and provide guidance for the clinical treatment of STEMI in hospitals and find a better method of AMI in our own country.Methods 48 patients with STEMI were enrolled in this study. All of these, 29 patients were male and 19 were female, aged of 38 to 70 years (mean 60.9±9.3 years). According to the ACC/AHA diagnostic criteria, all patients who were enrolled in the study with chest pain lasting more than 30 minutes; and with incidence time within 6 hours; and had associated ST elevation on their electrocardiograms (ECG) of 0.2 mv or more in the limb leads and of 0.1 mv or more in at least 2 chest leads without thrombolytic contraindications or cardiogenic shock. 48 cases were randomly assigned to facilitated PCI group (22 cases) and primary PCI group (26 cases). All of the patients had given informed consent before operation. Two groups were received the conventional therapy of acute myocardial infarction before the start, and need to take orally aspirin 300mg and clopidogrel 300mg one time. Facilitated PCI group was given low-dose thrombolytic therapy before making PCI and primary PCI group was directly carried out PCI procedure as soon as possible. Comparison of every clinical index after treatment between facilitated PCI group and primary PCI group was made. These indexes included the patency rate of IRA before and after PCI, ST segment resolution rate, left ventricular ejection fraction (LVEF), major adverse cardiac events (MACE, such as reinfarction, recurrent ischemia, congestive heart failure and death), stroke and bleeding complications. Results1. ST segment completely resolution rate (≥70%) in facilitated group was significantly higher than the proportion of the primary group (36.4% VS 11.5%), statistically significant difference (P<0.05). In the lower part of the ST segment resolution rate (30%～70%) and less than 30% of the ST segment resolution rate, the difference was not statistically significant(P>0.05).2. Facilitated group of IRA before PCI TIMIⅡ,Ⅲwas statistically significant different in the proportion of blood flow (P<0.05), respectively, (40.9% VS 11.5%, P=0.019) and (22.7% VS 3.8%, P=0.049); Facilitated PCI has significantly higher patency rate of IRA before PCI than primary PCI (63.6% VS 15.4%, P=0.001).3. Facilitated group of IRA after PCI TIMIⅡ,Ⅲwas not statistical different in the proportion of blood flow (P>0.05), respectively, (27.3% VS 31.8%, P=0.791) and (68.2% VS 65.4%, P=0.838); Facilitated PCI has similar patency rate of IRA after PCI as well as primary PCI (95.5% VS 96.2%, P=1.000).4. As to reinfarction, recurrent ischemia, congestive heart failure, stroke, bleeding complications, mortality during hospitalization and LVEF(>50%) in facilitated group and the primary group. Although there are different, all showed no statistically significance (P>0.05).Conclusions1. Compared with the primary PCI, facilitated PCI could achieve higher proportion of ST-segment resolution, and without increasing MACE and major hemorrhage bleeding.2. More importantly, it can realize of earlier myocardial reperfusion before PCI, and expect to fill gaps of the time that patients waiting for PCI, and save more myocardium.3. Facilitated PCI has similar IRA patency rate as well as primary PCI.4. Facilitated PCI may be one of the effective therapies for patients with STEMI that can not be directly used primary PCI in earlier period.