The Use Of Combined Thrombolysis And Antithrombotic Agents After Coronary Intervention For Thrombus Aspiration In Interventional Treatment Of STEMI Patients With High Thrombus Burden And Its Short-term Efficacy

Objective: To investigate the effect of residual thrombus on myocardial reperfusion in patients with high thromboembolic STEMI and the prognosis during hospitalization by using thrombolytic agents and antithrombotic agents after thrombus aspiration in emergency percutaneous coronary intervention(PCI).Methods: Retrospective analysis of acute ST segment elevation myocardial infarction(ST-elevation/myocardial infarction)with acute vascular occlusion and concurrent emergency PCI was performed in the Department of Cardiology,Jiangxi Provincial People’s Hospital from January 2015 to October 2017.Indicative STEMI)hospitalization data.According to the inclusion criteria and exclusion criteria,a total of 124 patients who met the study conditions were selected.According to the method of emergency PCI,the residual thrombus after thrombus aspiration of infarct-related artery(IRA)in patients with high thrombotic load in STEMI was grouped as follows: thrombolysis group,antithrombotic group,C,thrombolysis combined with antithrombotic group.Retrospective analysis of patients with coronary artery disease before and after treatment TIMI blood flow grade lesions,2 hours after electrocardiogram review,hospitalized patients with troponin(Troponin I c Tn I),myoglobin(Myoglobin MYOG)and creatine kinase isoenzymes(Creatine kinase isozyme CK-MB)peak,postoperative left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVVED),and major adverse cardiovascular events during hospitalization(Major cardiovascular events(MACE)occurred during the main period of the puncture site with or without bleeding,bleeding gums,nose bleeding,hematuria,cerebral hemorrhage and other bleeding clinical manifestations.Results: 1.Comparison of the characteristics of three groups of basic clinical data: age,sex,time of onset,risk factors for coronary heart disease(such as hypertension,diabetes,hyperlipidemia,smoking),number of infarction-related arteries,and number of diseased vessels in the three groups There was no statistical difference in other aspects(P>0.05)2.Three groups of intraoperative myocardial perfusion related indicators: after thrombus aspiration of a significant thrombosis,TIMI blood flow in infarct-related arteries can be restored to 2-3 levels.After infusion of thrombolytic urokinase or antithrombotic agent tirofiban through the aspiration catheter,the blood flow of the three groups was significantly higher than before,and most of the TIMI blood flow could reach grade 3 when the coronary artery was combined with tirofiban.After urokinase,the number of TIMI3 grades in the lesion blood vessel recovery was significantly higher than that in the monotherapy group(P<0.05).In patients with coronary microcirculation,the incidence of no-reflow and slow blood flow in urokinase plus tirofiban group was significantly lower than that in a single drug group,with a significant difference 3.Comparison of cardiac function,myocardial markers,and myocardial perfusion parameters after PCI in the three groups: The peak value of MYOG.CK-MB after combination of antithrombotic and thrombolytic agents was significantly lower than that of antithrombotics or thrombolytic agents alone.The difference was statistically significant.(P<0.05).The number of ≥50% drop in ST segment after combination therapy was much larger than that of single drug alone.The difference was statistically significant(P<0.05).4.The probability of occurrence of major adverse cardiovascular events and bleeding events during hospitalization in the three groups of patients: During the hospitalization of all patients,a total of 17 patients developed MACE,including 9 in the antithrombotic group,7 in the thrombolysis group,and 1 in the combined group.The incidence of MACE in the combined group was significantly lower than that in the single-agent group.The difference was statistically significant.No adverse bleeding complications occurred in the three groups of patients during hospitalization,and the difference was not statistically significant(P>0.05).Conclusion: 1.During emergency PCI,after thrombus aspiration in patients with high thrombus burden,intracoronary prothrombin and tirofiban can reduce the incidence of no-reflow,increase myocardial perfusion,and improve cardiac function.2.During emergency PCI,thrombus aspiration combined with intratracheal tirofiban and prourokinase reduces the incidence of MACE events during hospitalization in patients with high thrombus burden without increasing the risk of bleeding.