| Objective:To observe the clinical characteristics and angiographic features of spontaneous reperfusion(SR)in patients with acute ST-segment elevation myocardial infarction(STEMI);To explore the predictors of SR in infarct related artery(IRA);To investigate the effect of antithrombotic pretreatment before percutaneous coronary intervention(PCI)on SR of acute STEMI;To evaluate the prognosis between SR and NSR.Methods:Retrospective analysis of 206 patients diagnosed with acute STEMI and received emergent percutaneous coronary intervention(PCI);According to the results of coronary angiography(CAG),the TIMI2-3 grade was defined as 56 cases of SR group and TIMI0-1 grade was defined as NSR group with 150 cases;The clinical features,angiographic features and prognosis of the two groups were analyzed,zhen to explore the predictors of SR;According to preoperative antiplatelet pretreatment,the cases were divided into 105 cases of clopidogrel group and 101 cases of ticagrelor group,then To compare the spontaneous reperfusion rates in both groups;On the basis of load antiplatelet pretreatment,the all were divided into three groups,control group(Untreated)84 cases,heparin group(general heparin 70 ~ 100 U / kg)in 26 cases,tirofiban group(tirofiban l0 Ug/kg)96 cases,according to preoperative antithrombotic pretreatment,then compared the spontaneous reperfusion rates of each group.Results:1.The ratio of Pre-infarction angina,ECG down more than 50% and IRA located in LAD in SR group were higher zhan that in NSR group(all P<0.05),Stressful hyperglycemia and myocardial bridge were lower(both P<0.05);The levels of preoperative chest pain relief score,onset-to-medical therapy time,CK,CK-MB,cTnl,Scr NLR and PLR in SR group were lower zhan in NSR group(all P<0.05);2.Multivariable logistic regression analysis showed that,pre-infarction angina,onset-to-medical therapy time,ECG down more than 50%,NLR and PLR Can be used as predictors of SR;3.The spontaneous reperfusion rate of ticagrelor group was significantly higher than clopidogrel group(P<0.05);The spontaneous reperfusion rate of tirofiban group were significantly higher than control group(P<0.05);4.The incidence of major adverse cardiovascular events(MACE)in the SR group was lower than that in the NSR group(P<0.05),and the cardiac function is better than in NSR group(P<0.05)three months later.Conclusion:1.Acute STEMI had a certain rate of SR before PCI treatment;2.pre-infarction angina,onset-to-medical therapy time,ECG down more than 50%,NLR and PLR Can be used as predictors of SR;3.the selection of ticagrelor antiplatelet pretreatment,preoperative application of tirofiban,all contribute to SR;4.SR can reduce the incidence of MACE during hospitalization,be beneficial to the prognosis of patients. |
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