Clinical Observation Of Effect Of Different Intervention On Recent Prognosis In Patients With STEMI

OBJECTIVE:To analysis the effectiveness of different clinical interventionalprocedures on patients with ST elevation myocardial infarction(STEMI)retrospectively.METHODS:We Collected the data of patients admitted in our hospital with STEMIfrom 2006.1 to 2009.1,according to the administration of Tirofiban or not and thetime of administration,We divided the patients into three groups,patients in groupG0(n=101)was not treated with Tirofiban;patients in Group G1(n=43) isadministrated with Tirofiban just at the beginning of percutaneous coronaryintervention(PCI) whereas patients in Group G2(n=130) is pretreated with Titofibanas soon as they signed the Consent forms.In G2 group,according to the applicationof post-conditioning or not,we divided the patients into two subgroups:post-conditioning Group and Non-post-conditioning Group,We collected the clinicalinformation including baseline data,condition at the admission,information of PCIand cardiac events,bleeding events during hospitalization.Statistical analysis wereperformed.RESULTS:Among the three groups the proportion of male patients is 68.3%,72.1%and 77.3% respectively,it is significantly higher in group G2 compared with groupG0 (P＜0.05),there is no significant difference between other groups;The systolicblood pressure at admission is 133.96±25.54mmHg,122.42±26.91mmHg and130.11±24.73mmHg respectively,it's much lower in group G1 than in group G0(P＜0.05),there is no significant difference between other groups;The serum HDL-clevel is 1.42±0.36mmol/L,1.25±0.27mmol/L and 1.26±0.29mmol/L respectively,it'shigher in group G0 than in other two groups (P＜0.05),and the ratio of LDL-c/HDL-cis 1.90±0.15,2.14±0.21 and 2.21±0.15 respectively,it's significantly lower in groupG0 than in other two groups (P＜0.05);The proportion of the culprit lesion locating inleft anterior descending (LAD) is 42.6%,46.5% and 56.9% respectively,it is muchhigher in group G2 than in other two groups (P＜0.05);The proportion of the patientsreceiving post-conditioning procedures is 0%,2.3% and 16.1 %,which is significantlyhigher in G2 group than in other two groups(P＜0.05);percentage of patients who who didn't receive stents implantation is 8.5%,27.9% and 27.7% respectively,it's muchlower in group G0 than in other two groups (P＜0.05);the percentage of patientsreceiving drug-eluting stents is 81.9%,100%and 100% respectively,also is lower ingroup G0 than (P＜0.05),other baseline data concerning age,history of hypertension,history pf diabetes,smoking,time from onset of the symptom to admission,timefrom onset of the symptom to balloon dilatation,the number of lead with elevated ST,Killip grade at admission,central artery pressure,diastolic blood pressure atadmission,blood sugar at admission,fast blood sugar,serum BUN,serum Cr,TC,TG,LDL-c,VLDL-c,counts of white blood cells and the proportion of neutrophil,the number of lesion vessel,proportion of TIMI grade 3 of IRA,proportion ofthrombus aspiration,amount of contrast medium,Serum BUN,Cr after the procedure,diameter of stent or balloon,deployment pressure of the stent or balloon,the numberof the stent are comparable among three groups.The rate of the incidence ofno-reflow is 28.4%,31.9%,19.0% respectively among three groups,and it'ssignificant lower in group G2 than in other two groups(P＜0.05);The Corrected TIMIFrame Counts(CTFCs) is 29.05±8.09,32.09±8.15 and 22.62±3.13 respectively,it'smuch fewer in group G2 than in group G0 and G1 (P＜0.05);Proportion of TIMI 3grade flow is 86.1%,88.4% and 99.2% respectively,it is higher in G2 group than inother two groups(P＜0.05);The resolution of ST is 68.37±19.74%,66.05±16.64% and80.85±18.38% respectively,it's significant greater in group G2 than in other twogroups(P＜0.05),LVEF is highest in G2 group,is lowest in G1 group(50.89±6.86%,47.51±7.43%,53.26±6.03% respectively,P＜0.05);the concentration of CK is2000.31±1241.36iu/L,3271.16±2444.11iu/L and 1693.83±1142.73iu/L respectively,it's higher in group G1 than in other two groups(P＜0.05),there is no statisticaldifference between other groups;the concentration of CK-MB is 204.62±13 6.03 iu/L,314.93±218.62iu/L and 170.11±109.78iu/L respectively,it is higher in group G1 thanin other two groups(P＜0.05),other data including cardiac events,bleeding events,severe bleeding,PCIs for non-infarction related artery during hospitalization iscomparable among three groups.In G2 groups,patients undergoing post-conditioningsubgroup is much older than patients who didn't receive post-conditioning (67.62±9.97yrs Vs 58.78±12.3yrs,P＜0.05),and had a much lower diastolic central artery pressure (64.57±8.62mmHg Vs 70.76±12.55mmHg,P＜0.05),more lesions incoronary artery (2.29±0.78 Vs 1.88±0.85,P＜0.05),consuming more contrast medium(200.48±52.30ml Vs 159.36±46.11ml,P＜0.05),but the clinical outcomes have nosignificant difference.CONCLUSION:Pretreatment with Tirofiban in patients with STEMI may reduce theoccurrence of no-reflow,improve coronary blood perfusion,improve cardiac functionwithout increasing bleeding events but did not affect the cardiac events duringhospitalization.Simultaneously undergoing post-conditioning did not make anydifference on clinical outcome,perhaps related to a more complicated lesion and aless patient's number in post-conditioning subgroup.