Study Of Intracoronary Arterial Retrograde Thrombolysis Combined With PCI On The Prognosis Of AMI Patients

Objective: To investigate the effect of intracoronary reverse application of recombinant human prourokinase combined with PCI on the prognosis of patients with ST-segment elevation myocardial infarction(STEMI).Methods: One hundred and twenty patients with STEMI undergoing emergency PCI were selected and divided into 4 groups according to relevant ethics and randomization methods,with 30 patients in each group,Including PCI group(Group A),thrombus aspiration + PCI group(Group B),PCI + intracoronary forward thrombolysis group(Group C)and intracoronary arterial retrograde thrombolysis + PCI group(Group D).Baseline data,postoperative TIMI blood flow classification,corrected TIMI frame count(CTFC),the percentage of 2h ST-segment resolution(STR)≥ 50%,the incidence of noreflow/slow flow(NR/SF),left ventricular ejection fraction(LVEF),peak cardiac troponin I(c Tn I),peak brain natriuretic peptide(BNP)and TIMI bleeding were compared among the four groups.LVEF and major adverse cardiovascular events(MACEs)were recorded at 3 months of follow-up,and the relevant indicators were compared.Results:(1)In group D,the incidence of TIMI flow ≤ grade 2,CTFC,NR/SF incidence,c Tn I and BNP peak were significantly lower,and the percentage of 2h STR ≥50% and LVEF were significantly higher(all P<0.05)than those in groups A,B,C.(2)There was no statistically significant difference in the incidence of TIMI bleeding during hospitalization among the four groups(P>0.05).(3)The incidence of rehospitalization for heart failure was significantly lower and LVEF was significantly higher in group D than those in groups A,B and C at 3 months of follow-up(P<0.05).(4)Binary logistic regression analysis showed that the left anterior descending involvement was a risk factor for the NR/SF phenomenon in STEMI patients(OR=2.786,95%CI:1.153-6.733,P=0.023).(5)The area under the ROC curve for LAD involvement to predict the occurrence of NR/SF phenomenon in STEMI patients after surgery was 0.623(95% CI: 0.511-0.735,P=0.038).Conclusion: Intracoronary reverse application of recombinant human prourokinase combined with PCI is effective in reducing the incidence of NR/SF,improving myocardial microcirculatory perfusion,reducing myocardial cell necrosis,and improving left ventricular systolic function and its prognosis in patients with STEMI without increasing the risk of bleeding.LAD involvement is a risk factor for the development of the NR/SF phenomenon in STEMI patients.Figure [4] Table [6] Reference [173]...