Analysis Of The Effect And Influencing Factors Of Thrombolytic Therapy In Acute ST-segment Elevation Myocardial Infarction

Objective: To analyze the effect of thrombolytic therapy and the factors affecting thrombolytic recanalization in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods: A total of 140 patients with STEMI who received intravenous thrombolysis were divided into two groups according to the effect of thrombolysis: recanalization group and non-recanalization group.Age,gender distribution,body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate,past medical history(coronary heart disease treatment history,diabetes,hypertension,cerebrovascular disease),smoking history,time of first medical contact-anticoagulation(FMC-anticoagulation),ACT/APTT standard-reaching rate,location of infarction,Killip grade,reperfusion time,Grace score,Crusade score,intervention related index,left ventricular ejection fraction(LVEF),incidences of major adverse cardiac events(MACE),and the incidences of bleeding events were analyzed and compared between the two groups.Results: A total of 140 patients were enrolled in this study.There were no significant differences in age,gender distribution,body mass index(BMI),smoking history,systolic blood pressure(SBP),diastolic blood pressure(DBP),location of infarction,go to hospital to CAG time,diabetes,hypertension,cerebrovascular disease,Grace score and Crusade score between the two groups.(P>0.05).The level of heart rate,the proportion of Killip≥2grade and the history of coronary heart treatment disease in the recanalization group were significantly lower than those in the non-recanalization group,while the proportions of FMC-anticoagulation time < 15 min,ACT/APTT reaching the standard and symptom onset-thrombolysis time <2 h in the recanalization group were significantly higher than those in thenon-recanalization group(P<0.05).In the course of operation and cardiac markers,there were no significant differences in the proportion of infarction-related arteries(LAD,LCX,RCA),the proportion of multi-vessel lesions and puncture paths(via radial artery and femoral artery)between the two groups(P > 0.05).The number of stents,total stent length,levels of peak CK,peak CKMB,and peak c Tn I,incidence of no reflow,use of thrombus aspiration,intracoronary thrombolysis and intracoronary administration of GPⅡb/Ⅲa receptor antagonist in the recanalization group were significantly lower than those in the non-recanalization group(P<0.05).The proportions of postoperative TIMI 3 grade and postoperative TMPG 3 grade in the recanalization group were significantly higher than those in the non-recanalization group.Compared with the indexes of prognosis and follow-up,the LVEF of recanalization group was significantly higher than that of non-recanalization group(56.73±6.70 vs.50.35±10.00,P < 0.001).During follow-up,there was no significant difference in the incidences of septal perforation,pseudoaneurysm,in-stent acute thrombosis and cardiogenic death between the two groups.The incidences of heart failure and malignant arrhythmia in the non-recanalization group were significantly higher than those in the recanalization group(P< 0.05).There was no significant difference in the incidence of bleeding events during hospitalization between the two groups(P>0.05).During the 3-month follow-up,there was no significant difference in recurrent angina pectoris,malignant arrhythmia and cardiogenic death between the two groups(P>0.05).The incidence of heart failure in the non-recanalization group was significantly higher than that in the recanalization group(2.1% vs.11.6%,P =0.017).By analyzing of independent influencing factors of thrombolytic recanalization,the results showed that that symptom onset-thrombolysis time(OR 4.143,95% CI 1.639-10.470,P=0.003),FMC anticoagulant time(OR 3.479,95% CI 1.359-8.908,P=0.009),ACT/APTT reaching the standard(OR 3.685,95% CI 1.460-9.299,P=0.006)and previous coronary heart disease treatment history(OR 4.380,95% CI1.783-10.761,P=0.001)were the influencing factors of thrombolytic recanalization.Conclusion: 1.Thrombolytic recanalization in STEMI patients can significantly shorten the total myocardial ischemia time,improve cardiac function,reduce the occurrence of MACE,and do not increase the risk of bleeding.2.Early thrombolysis,early use of anticoagulants,ACT/APTT reaching the standard and no previous history of coronary heart disease are conducive to thrombolytic recanalization.