| Objectives To evaluate the efficacy and safety of intracoronary thrombus aspiration combined with recombinant human prourokinase(rhPro-UK)in the treatment of patients with ST-segment elevation myocardial infarction(STEMI)in coronary intervention.Methods From March 2017 to March 2018,69 patients with acute ST-segment elevation myocardial infarction diagnosed by Tangshan Gongren Hospital and emergency coronary angiography showed high thrombosis load were included in the study.The patients were randomly divided into thrombus aspiration combined with recombinant human prourokinase group(combined treatment group)in 33 cases,and only the coronary thrombus aspiration group(simple treatment group)in 36 cases.All patients received aspirin 300 mg,clopidogrel 300 mg or ticagrelor 180 mg before PCI.The intervention group was treated with thrombus aspiration combined with recombinant human prourokinase.The control group was only applied with thrombus aspiration.General data,myocardial perfusion levels,STR,CK-MB,CK,and bleeding events were compared between the two groups.Echocardiography was reexamined 1 and 6 months after PCI.MACCE events were followed up for 6 months.Results 1 There were no significant differences in general clinical data between age,BMI,gender,heart rate,liver function,renal function,smoking history,family history,hypertension,diabetes,hyperlipidemia,and cerebrovascular disease(P>0.05).There were no significant differences between the two groups in diseased blood vessels,Killip grading,operative time,and the number of stents implanted(P>0.05).2 Evaluation of vascular perfusion after PCI in both groups:The number of patients with postoperative vascular recovery TIMI blood flow level 3 in the intervention group and the control group was 32(96.97%)and 33(81.67%),no statistical difference(P>0.05).The CTFC counts of the two groups were 24.63±2.32 and 26.95±3.48,and the difference was statistically significant(P<0.05).The rate of TMPG3 was 31(93.94%)and 27(75.00%)in the two groups,the difference was statistically significant(P<0.05).The ST-segment fall rate of ECG was 28(28.85%)and 23(63.89%)at 2 hours after PCI,and the difference was statistically significant(P<0.05).The ST-segment fall rate of ECG at 24 hours after PCI was 30(90.91%)and 30(83.33%),no statistical difference(P>0.05).3 Comparison of myocardial enzymes after PCI in both groups:The CK of the intervention group and the control group were 1165.51±731.62(U/L)and 1485.6±819.34(U/L),the difference was statistically significant(P<0.05).The CK-MB of the two groups was 126.42±78.47(U/L)and 156.53±86.65(U/L),and the difference was statistically significant(P<0.05).4 Cardiac function comparison:One month after PCI,the ejection fractions of the two groups were 54.53±5.12(%)and 53.31±4.84(%),and the difference was not statistically significant(P>0.05);The left internal diameters of the two groups were 52.73±6.31(mm)and 53.99±4.34(mm),and the difference was not statistically significant(P>0.05).Six months after PCI,the left ventricular ejection fraction was 59.15±5.47(%)and 56.17±7.28(%),and the difference was statistically significant(P<0.05).The left internal diameters of the two groups were 51.52±5.63(mm)and 53.81±6.13(mm),and the difference was not statistically significant(P>0.05).5 Comparison of bleeding events during hospitali in both groups :In the intervention group,there were 0 cases of massive hemorrhage,0 case of small hemorrhage,and 2 cases of microbleeds,totaling 2 cases.In the control group,there were 0 cases of massive hemorrhage,0 cases of small hemorrhage,2 cases of microbleeding,and a total of 1 cases.There was no statistical difference(P>0.05).6 Comparison of two groups of MACCE events:In the intervention group,there were 3 cases of angina pectoris,0 cases of revascularization,0 cases of non-fatal myocardial infarction,0 cases of cardiac death,0 cases of stroke and 0 cases of heart failure,totaling 3 cases;In the control group,there were 4 cases of angina pectoris,0 cases of revascularization,0 case of non-fatal myocardial infarction,0 case of cardiac death,0 case of stroke and 1 cases of heart failure,totaling 5 cases,no statistical difference.Conclusions Intravenous thrombectomy combined with recombinant human prourokinase in patients with ST-segment elevation myocardial infarction in the treatment of coronary intervention:(1)Reduce the incidence of coronary no-reflow,improve myocardial perfusion,reduce myocardial infarct size,improve left ventricular ejection function.(2)Clinical safety is feasible and does not increase the incidence of MACCE events and bleeding events.Figure3,Table8,Reference 130... |
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