Clinical Study Of Fibrinolytic Enzyme Preconditioning In Delayed Coronary Intervention

ObjectiveTo observe the clinical efficacy of preoperative Fibrinogenase in patients with acute myocardial infarction(AMI)undergoing selective percutaneous coronary intervention(PCI).Methods130 Patients with acute myocardial infarction from the onset to the admission time of more than 12 hours were randomly divided into experimental group(64 cases)and control group(66 cases).Preoperative heart function.Both groups received conventional treatment and were successfully performed PCI on 7-14 days after onset.The treatment group was treated with plasmin.Comparing clinical baseline conditions,TIMI blood flow classification,corrected TIMI frame counts(CTFC),no-reflow/slow flow status,changes in bleeding-related parameters,and heart during PCI in both groups Changes in color Doppler ultrasound and follow-up of cardiovascular events.Results1? Comparison of case characteristicsThere was no statistical difference between the two groups in gender,age,smoking history,drinking history,hypertension,diabetes,history of dyslipidemia,TIMI grade 3 blood flow before IRA opening,myocardial infarction status,and preoperative cardiac function.(P<0.05).2?Comparison of laboratory indicators between two groups of patientsThere was no significant difference in blood routine,liver function,renal function,and prothrombin time(PT)levels before and after treatment between the two groups,with P values >0.05.The activated partial thromboplastin time(APTT)and thrombin time(TT)were significantly prolonged in the experimental group,and fibrinogen(FIB)was significantly decreased compared with the control group,and the difference was statistically significant(P<0.05).3.Comparison of myocardial perfusion after opening of IRA in two groups of patientsIn the control group,49 patients(74.2%)had coronary angiographic blood flow after coronary angiography and CTFC(30.80 ± 4.10),17 patients(25.8%)had no reflow/slow blood flow;the crown of the experimental group after IRA was opened.There were 57 cases(89.1%)of TIMI grade 3 blood flow,CTFC(21.00±5.10),and 5 cases(10.9%)of patients with no reflow/slow blood flow.In the plasmin group surgery,the TIMI3 blood flow increased significantly after the IRA was opened,and the CTFC value and the incidence of no-reflow/slow blood flow decreased.The difference was statistically significant(P<0.05).4.Comparison of cardiac function changes and major cardiovascular adverse events and bleeding eventsIn the experimental group,the ejection fraction of cardiac ultrasound and New York heart function were higher in the experimental group than in the control group(P<0.05).The number of bleeding in the control group was 2 in the bleeding event and 3 in the experimental group,all of which were subcutaneous ecchymosis,and no special treatment was performed.The difference was not statistically significant(P>0.05).Conclusion1.Fibrinogenase Injection can reduce the incidence of IRA no reflow / slow blood flow,thereby promoting the recovery of postoperative cardiac function and reducing the incidence of major adverse cardiovascular events.2.soluble enzyme can obviously prolong APTT,TT,reduce the content of FIB,but have no obvious effect on liver and kidney function and platelet,the risk of bleeding is small and the safety is high.