| Aims:To observe whether combined thrombus aspiration,intracoronary injection of urokinase,tirofiban and nitroglycerin for reducing thrombus burden can get optimizing the emergency PCI,improve microcirculation and the myocardial tissue perfusion as well as cardiac systolic function in the long-term.Methods and Results:1.We selected patients with acute anterior myocardial infarction presented with high thrombus burden.Random according to 1:1.The combination of thrombus aspiration,intracoronary injection with 100 thousand units of urokinase,5ml tirofiban,and 200ug nitroglycerin was performed in the experimental group,the control group was treated with thrombus aspiration,and both groups received stents implantation.The ratio of TIMI 3 grades and TMPG(TIMI myocardial perfusion grade)3 grades as well as IMR(the index of microcirculatory resistance)immediately after PCI were detected,CK-MB peak value postoperative,and the ratio of ST segment resolution(STR)above 70%after 2 hours of PCI were assessed.17 segments of left ventricle EF value with three-dimensional echocardiography was meassured.We selected TIMI,TMPG,STR,EF as the primary end point.The secondary end points was 1 year MACE(including worsened heart failure.recurrent angina pectoris,recurrent acute myocardial infarction,and cardiac death).We also defined the BARC defined bleeding as the security point.2.There was no difference between two groups at baseline clinical data except smoking proportion was higher in experimental group.And also there was no differe-nce in stenosis seroiusness and stent implantation number.3.At the primary end point,the ratio of TMPG 3 was higher in the experimental group(68.2%vs 33.3%,p=0.006).IMR was significantly lower than control(31.50±13.39U vs 62.72±22.80U,p=0.002).STR more than 70%was higer in the experimental group(63.6%vs 25%,p=0.016).Heart systolic function analysis suggested that EF value was higher at the basal anterolateral and apex at 1 month in the experimental group,(51.6±7.7)%vs(45.7±7.1)%p=0.014,(25±7.4)%vs(19.8±8.8)%p=0.004,respectively.At 3 months,EF value was significantly higher at the apical anterior,apical lateral,and apex than control,(32.6±7.0)%vs(28.1±12.9)%p=0.005,(42.2±7.2)%vs(33.5±13.4)%p=0.001,(24.3±8.8)vs(19.7+19.2)%p=0.003,respectively.And also overall EF value of experimental group was significant higher in 3 months,as(42.1±3.1)%vs(40.0±3.0)%,p=0.049.Apical anterior EF value was significantly higher than the control group,(34±8.5)%VS(24.7±14.9)%at 6 months,p=0.016.Mid anterolateral and apical lateral EF value was higher in the experimental group at 1 year,(52.7±7.7)%vs(44.1±9.1)%p=0.005,(41.0±10.4)%vs(29.9±15.9)%p=0.023,respectively.And we found the overall EF value was also higher than control group at 1 year,(41.9±2.9)%vs(39.8±3.5)%.p=0.042.There was a significant negative correlation between IMR value and EF value at 3 months and 1 year,r=-0.145 p=0.013,r=-0.333 p=0.031,respectively.4.At the secondary end point,there was no significant difference at MACE(worsened heart failure,recurrent angina,recurrent acute myocardial infarction,cardiac death)compared with the control group.However,we found that the more segmental left ventricular aneurysm in control(27 vs 9,p=0.011),and 3 cases of ventricular thrombus in control.5.There was no significant difference in bleeding between the two groups defined by BARC.Conclusion:The combined use of thrombus aspiration,intracoronary injection of urokinase,tirofiban and nitroglycerin can reduce thrombus burden,improve myocardial tissue perfusion,and improve cardiac function in the long term,and can also safely use in patients with acute anterior segment elevation myocardial infarction patients with high thrombus burden.IMR can have a good predictive value for long-term cardiac function. |
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