| Objective:1.To observe the effect of total ischemic time(TIT)on the reperfusion effect of acute ST-elevation myocardial infarction;2.To compare the pre-PCI loading with different anti-platelet drugs when the total ischemic time is the same.The effect of ticagrelor and clopidogrel on the correlative indexes of coronary blood flow after reperfusion therapy;3.When the total ischemic time is the same,observe the pre-PCI anti-platelet drug ticagrelor loading time on coronary blood Effects of infusion;4.Comparison of short-term(3 months)cardiac function between antiplatelet drugs(ticagrelor and clopidogrel)in patients with ST-elevation myocardial infarction and comparison of Major cardio-cerebral vascular adverse events(MACE),angina pectoris,bleeding,and dyspnea,and assessment of efficacy and safety.Methods:A retrospective study of 187 patients with acute ST-segment elevation myocardial infarction diagnosed in the Department of Cardiology,Sichuan Provincial People's Hospital between November 2016 and October 2017 and who underwent primary PCI within 12 hours of onset.Of these,128 were preloaded with aspirin(300 mg)and ticagrelor(180 mg)preloaded with PCI(defined as group T),and loaded with antiplatelet drugs aspirin(300 mg)and clopidogrel(300 mg).Fifty-nine cases(defined as group C).The time from initial onset to opening of the blood vessels(ie total ischemic time),onset to first medical contact time,first medical exposure to blood vessel opening time,first loading of dual antiplatelet drugs to blood vessel opening time were recorded.The total ischemic time of group T was divided into <180 min group(defined as T1 group,57 cases)and ?180 min group(defined as T2 group,71 cases).The total ischemia time in group C was divided into <180 min group(defined as C1 group,33 cases)and ?180 min group(defined as C2 group,26 cases).The T group first load dual antiplatelet drugs to the blood vessel opening time was divided into ?90 min group(defined as D1 group,73 cases)and> 90 min group(defined as D2 group,55cases),D1 group and D2 group The median time was 58 minutes and 117 minutes,respectively.Comparing TIMI blood flow within group T,group C,group D1,groupD2,corrected TIMI flow count frames(CTFC),and ST segment fall index within 2hours after emergency PCI(STR)and other myocardial perfusion indicators,and B-type natriuretic peptide,myocardial injury markers,D-dimer,inflammation indicators.Comparison of short-term(3 months)cardiac function between antiplatelet drugs(ticagrelor and clopidogrel)in patients with ST-elevation myocardial infarction and comparison of major cardiovascular and cerebrovascular adverse events(MACE)and recurrent angina between the two groups The incidence of bleeding,dyspnea,and assessment of its efficacy and safety.Relevant information was collected through the hospital medical record system,medical record management system,Neusoft PACS imaging system,telephone follow-up and outpatient follow-up.Results:1.The complete fall rate of STR in T1 group was higher than that in T2 group(P<0.05)within 2 hours after primary PCI.The CTFC in T1 group was lower than that in T2 group(P<0.05).There was no significant difference in postoperative TIMI flow grading(P>0.05).In C1 group,the complete fall rate of STR was higher than in C2group(P<0.05)within 2 hours after primary PCI.The CTFC in C1 group was lower than that in C2 group.(P<0.05),TIMI flow grading was not statistically significant between preoperative and postoperative C1 and C2 groups(P>0.05).2.The complete fall rate of STR within T1 group was higher than that of C1 group within 2 hours after primary PCI(P<0.05).CTFC of T1 group was lower than that of C1 group(P<0.05).T1 and C1 groups were preoperatively TIMI flow grade after operation was not statistically significant(P>0.05).In T2 group,the complete fall rate of STR within 2 hours after primary PCI was higher than that of C2 group(P<0.05).CTFC of T2 group was lower than that of C2 group.(P<0.05),TIMI and C2 had no statistical significance in preoperative and postoperative TIMI flow grading(P>0.05).3.The complete fall rate of STR in D2 group was higher than that of D1 group(P<0.05)within 2 hours after primary PCI,and the CTFC of D2 group was lower than that of D1 group(P<0.05).The D1 and D2 groups were preoperatively,TIMI blood flow classification after operation was not statistically significant(P>0.05).4.There was no significant difference in cardiac LVEF values between the T and C groups during hospitalization.However,the LVEF values of cardiac ultrasound ingroup T were significantly better than those in group C(P<0.05).The overall MACE event and recurrence of recurrent angina were lower in the T group than in the C group.The difference was statistically significant(P<0.05).In adverse reactions,the incidence of bleeding events and dyspnea in both groups was not statistically significant(P>0.05).Conclusion1.For patients with acute ST-segment elevation myocardial infarction,shortening the total delay time of reperfusion can bring about better improvement of STR and CTFC,suggesting that shortening the total ischemic time can achieve better reperfusion effect in this type of patients;2.When the total ischemic time is the same,ticagrelor can restore STR and CTFC after PCI more effectively than clopidogrel,suggesting that ticagrelor is more effective than clopidogrel in the reperfusion of myocardial ischemia.it is good;3,in the case of a total ischemic time,the longer the time of loading ticagrelor to the blood vessel opening,the better the improvement of STR and CTFC after PCI,suggesting that the patient is diagnosed with acute ST-elevation myocardial infarction Dual antiplatelet drugs should be loaded as soon as possible to improve myocardial reperfusion.4.In the short term,ticagrelor has a better LVEF than clopidogrel,which means that ticagrelor can better improve cardiac function,improve patient's prognosis,reduce the occurrence of MACE,and does not increase the risk of bleeding.. |
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