Comparison Of Different Reperfusion Methods In Treatment Of Elderly STEMI

Objective: To compare the clinical effectiveness and prognosis of different elderly acute ST elevated myocardial infarction(STEMI)patients by intravenous thrombolytic therapy,Salvage treatment PCI after failure of Thrombolysis and direct PCI(PPCI)treatment.Methods: A retrospective study of left ventricular end diastolic diameter was conducted in 1338 elderly patients(65-75 years old included)who met the STEMI diagnostic criteria and completed follow-up.According to the actual situation,the patients are divided into groups according to the time of treatment and the different ways of reperfusion.Group A(1109 cases)was treated with PPCI.Within 12 hours after the onset of the disease,the patients received PCI;In group B,64 patients(64 cases)received intravenous thrombolysis within 3 hours after the onset of the disease,among them,patients receiving other treatments were divided into group B1,patients receiving remedial PCI after thrombolysis were divided into group B2.In group C,165 STEMI patients(165 cases)received intravenous thrombolysis within 3-12 hours after the onset of the disease were divided into group C1 and group C2;Group D was the sum of group B1 and group C1(184 cases),group E was the sum of group B2 and group C2(45 cases).The patients in PCI group were treated with intravenous thrombolytic therapy within12 hours after onset,but still had severe chest pain or persistent ischemia,and ECG or ST-segment elevation Max lead decreased less than 50%,alternatively,evidence of re-occlusion or re-infarction,such as re-elevation of St Segment,may be transferred to the Center for Remedial PCI.The treatment scheme of all groups had all followed STEMI guidelines.Follow-up index All the1338 patients were followed up 30 days、1year after operation or telephone.Comparison of bleeding events during hospitalization.Follow-up indicators included MACE,LVEF and LVEDD.All of postoperative patients accepted the outpatient follow-up within 30 days 、 1year.Differences between hospitalization and follow-up period in MACE,LVEF and LVEDD indicators were compared.Results: The result analysis included all patients.(1)There were no statistical differences between the groups in terms of the patients baseline data and clinical data.(2)There was no significant difference in the incidence of bleeding among the every group(P>0.05);The incidence of mace events during follow-up period: At 30 day follow-up,there was significant difference in the incidence of heart failure between group A and group B、group A and group E((P <0.05),there was no significant difference in the occurrence of MACE events between the other groups(P>0.05);One year follow-up:The cardiovascular mortality and heart failure of group A was lower than that of group B、 group C and group E,with statistical significance(P<0.05);There was no significant difference in cardiovascular death between group A and group D(P > 0.05).(3)During the follow-up period,LVEF and LVEDD were similar in Group A and Group D,there was no statistical significance(P >0.05);At 30 days and 1year follow-up,LVEF of group A was higher than that of group B、group C and group E,and LVEDD of group A was lower than that of group B and Group E(P<0.05),LVEDD in group A was lower than that in group C at 1 year follow-up;the LVEDD of group A was lower than that of group B and group E.the LVEDD of group A was lower than that of group C only in one year follow-up;The LVEDD of group D was lower than that of group E at 30 days and 1year follow-up,,and the LVEF of group D was higher than that of group E only at one year follow-up,the difference was statistically significant(P < 0.05).Conclusion: Direct PCI may be the most effective method of reperfusion therapy for elderly patients with STEMI.As for the elderly patients within 3 hours,thrombolytic therapy method is not inferior to the direct PCI in terms of immediate effect and prognosis of 30 days、1year.Thrombolysis is safe in the elderly patients with STEMI.Thrombolysis is not the end point of treatment for the elderly patients with STEMI.Conventional CAG is needed.The recovery of coronary blood flow in the patients has been known.If necessary,PCI can be remedied.