| Research background and objective:This study retrospectively investigated patients with acute coronary syndrome(ACS)treated in Lincang People's Hospital in recent 2 years,to understand the current treatment of ACS,and compare the efficacy of different intervention strategies for ACS patients under realistic medical conditionsResearch subjects and methods:ACS patients(including patients visited firstly and transferred to our hospital)treated in Lincang People's Hospital between January 2015 and December 2016 were collected as subjects,including 188 patients with STEMI and 94 patients with NSTEMI.For patients with STEMI,current treatment was investigated;and the incidence of MACEs,hospital stay and hospitalization expenses during hospitalization were compared between no Coronary artery reperfusion medication group(n=122)and early urokinase-induced thrombolysis group(n=66).For patients with NSTEMI,the incidence of MACEs and bleeding and improvement in LVEF during hospitalization and treatment(3 months)were compared between no tirofiban group(n=52)and tirofiban group(n=42).Results:1.Among the 188 patients with STEMI,1)the average duration from onset to the first medical contact was 5.78 ± 5.16 h;2)the proportion of calling 120 was 33.51%;3)the average duration of the first electrocardiogram examination was 6.15± 5.47 h;4)the average duration of firstly obtaining results of cardiac troponin was 7.21 ± 6.34 h;6)the proportion of thrombolysis was 35.11%;7)the average duration of thrombolysis was 6.11 ± 5.29 h;7)47(25%)patients firstly visited township hospitals,4.2%of whom underwent thrombolysis,65(34.57%)patients firstly visited county secondary hospitals,16.92%of whom were treated with thrombolysis,and 76(40.43%)patients firstly visited municipal tertiary hospitals,56.58%of whom received thrombolysis,there was a significant difference in the thrombolysis rate between different grade Firstly visited hospitals(P<0.05);8)Compared to the 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation,only 21 patients(11.17%)completed the ECG examination within 10 minutes after the first medical contact;9 patients(13.64%)received thrombolysis therapy within 10 minutes after the ECG was completed and the STEMI was diagnosed.2.In patients with STEMI,the incidence of MACEs,Average hospitalization time and hospitalization expenses during hospitalization in the urokinase-induced thrombolysis group were lower as compared with the no emergency coronary revascularization medication group(both P<0.05).3.In patients with N STEMI,the incidence of MACEs during hospitalization and recent was lower while the incidence of mild bleeding events was higher in the tirofiban group than that in the no tirofiban group(both P<0.05).Moderate bleeding in both groups presented no statistical significance(P>0.05).No severe bleeding occurred in both groups.After treatment for 3 months,the improvement difference of LVEF in the tirofiban group was superior to the general medication group(P<0.05).Conclusion:1.For frontier areas with limited reconstruction methods,urokinase-induced thrombolysis still can bring about significant benefits.But the proportion of thrombolysis remains low.Under current medical status,the key to improving the efficacy of STEMI treatment is to reduce the time delay in treating patients and medical system?strengthen the training of primary doctors?increase the proportion of thrombolysis,shorten the duration of thrombolysis,However,the joint efforts of the public,medical institutions and governments are needed.2.For patients with NSTEMI,tirofiban can reduced the incidence of MACEs during hospitalization and the follow-up(3 months)and improve prognosis,but increase the incidence of mild bleeding during treatment.However,the incidence of moderate and severe bleeding shows no obvious increase.Comparison of benefits and risks reveals that in a therapeutic regimen with the single drug for NSTEMI,early tirofiban for intensive antiplatelet therapy is appropriate. |
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