The Preliminary Application Of Intravenous Thrombolysis Combined With Emergency PCI In Reperfusion Therapy Of Acute Myocardial Infarction

Objective:To observe the efficacy and safety of intravenous thrombolysis combined with emergency percutaneous coronary intervention(PCI)in reperfusion therapy of ST segment myocardial infarction,provides a new scheme to improve the status of STEMI reperfusion therapy in China.Methods:A total of 50 STEMI patients who were admitted to the 264 th Hospital of PLA within 12 h since onset of their symptoms were divided into thrombolysis combined with emergency group(n=20)and primary PCI(pPCI)group(n=30)according to whether the patients received intravenous thrombolytic therapy.The primary end point were TIMI(Thromboiysis In Myocardial Infarction)flow grade of Infarct-related artery before PCI treatment,corrected TIMI frame count(CTFC)and TIMI myocardial perfusion grade(TMPG)after PCI treatment;the incidence rate of major adverse cardiac events(MACE)in-hospital;the secondary end point events were the incidence rate of bleeding during hospitalization and incidence of MACE follow-up in 1 years.Results:There was no significant difference between the clinical baseline of two groups.The median time of Outpatient to commencement of reperfusion therapy in the thrombolysis combined with emergency PCI group was significantly shorter than pPCI group(32.0minvs.72.5min,p<0.05).Infarct-related artery blood flow grade TIMI or thrombolysis combined with emergency PCI group after coronary angiography,significantly higher than pPCI group(60% vs.16.7%,p<0.05),the percentage of high burden thrombus in the thrombolysis combined with emergency PCI group was significantly lower than pPCI group(20% vs.50.0%,p<0.05);after PCI,the two groups TIMI flow grade reached the proportion of grade 3 has no obvious difference,but TMPG reached 3 grade in the thrombolysis combined with emergency PCI group was significantly higher than pPCI group(85% vs.53.3%,p<0.05),and postoperative CTFC frames was also lower than pPCI Group [(28.5±3.0)vs.(31.5±3.8),p<0.05)].There was no significant difference in the incidence of MACE between the two groups during the hospitalization and in the follow-up period of 1 years.There was also no significant difference in the incidence of bleeding complications between the two groups.Conclusion:Based on the current status of STEMI reperfusion therapy in our country,Intravenous thrombolysis combined with emergency PCI in the treatment of patients with STEMI can significantly shorten the time of reperfusion therapy,and the curative effect is not inferior to the primary PCI,and did not increase the risk of bleeding,may provide a practical reference strategy for improving the reperfusion therapy of STEMI.