Effects Of Different Reperfusion Strategies On Cardiac Function And Coronary Microcirculation In Patients With Anterior STEMI

Objectives To explore the effects of different reperfusion strategies on cardiac function and coronary microcirculation in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 107 patients who were diagnosed with acute anterior ST elevation myocardial infarction at the Heart Center of Hebei Provincial People's Hospital from October 2017 to October 2019 were selected.According to the different reperfusion strategies,they were divided into three groups: 13 cases in the PCI group with successful elective thrombolysis,12 cases in the PCI group with failed thrombolysis and 82 cases in the direct percutaneous coronary intervention group(PPCI group).Analysis of baseline clinical data,microcirculation related indicators,cardiac function parameters at 7 and 90 days after reperfusion,incidence of major adverse cardiac events(MACEs)during hospitalization and 90 days after reperfusion,and incidence of bleeding events at 90 days after reperfusion rate.All statistical data were processed using SPSS25.0 software,and the difference was considered statistically significant at P<0.05.Results 1 Baseline clinical data of three groups of patients: The three groups of patients in terms of age,gender,body mass index,high risk actors for coronary heart disease(including hypertension,diabetes,smoking,stroke,etc),white blood cell count,hemoglobin,serum creatinine,CK-MB peak,total cholesterol,triglycerides,low There were no statistically significant differences in density lipoprotein,Killip classification,number of coronary artery lesions,and vascular sites of criminals(P>0.05).The total ischemic time of the three groups of patients was less than that of the successful PCI group and the PCI group was less than that of the PCI group.There was a statistical difference(P<0.05).2 Microcirculation index of three groups of patients:the proportion of TIMI blood flow grade 3 and TMPG grade 3 after reperfusion in the three groups was higher in the PPCI group than in the thrombolysis failure recovery PCI group and the thrombolysis successful elective PCI group(P=0.003,P=0.016),the difference statistically significant.The CTFC levels of the three groups of patients after reperfusion were lower in the PCI group than in the selective PCI group for successful thrombolysis.The PCI group was lower than the PCI group for thrombolysis failure(P=0.001).Thedifference was statistically significant.3 The snack function parameters of the three groups of patients at different times:There was no significant difference in LVEF and LVEDD in the three groups of patients 7 days after reperfusion(P=0.410,P= 0.612).There was no statistically significant difference in LVEDD and WMS between the three groups of patients 90 days after reperfusion(P>0.05).The LVEF level of the three groups of patients improved significantly after 90 days of reperfusion,the difference was statistically significant(P=0.016),and the PPCI group was higher than thrombolysis The successful elective PCI group was higher than the thrombolytic failure rescue PCI group.4 The incidence of MACEs in the three groups of patients: There was no statistically significant difference in the incidence of MACEs in the three groups of patients during hospitalization(including cardiogenic death,malignant arrhythmia,severe heart failure,recurrent myocardial infarction,target vessel reconstruction)(P>0.05).90 days after reperfusion,there was a statistically significant difference in the incidence of MACEs among the three groups in patients with malignant arrhythmia,severe heart failure,and recurrent myocardial infarction(P=0.018,P=0.032,P=0.01).5 Adverse bleeding events in the three groups: There were no severe bleeding events 90 days after reperfusion in the three groups;mild bleeding events were successful in thrombolysis,1 case was selected in the PCI group,1 case was in the PCI group,and 0 cases were in the PPCI group;no obvious bleeding events were 1 case,There were 0 cases and 3 cases,and there was no statistical difference between the three groups(P>0.05).Conclusions 1 Compared with successful elective PCI and thrombolytic failure rescue PCI,PPCI can effectively improve coronary blood flow and myocardial microcirculation perfusion in patients with anterior STEMI.2 PPCI is more advantageous in improving the cardiac function of patients with anterior STEMI and reducing the incidence of MACEs.Figure [0];Table [5];Reference [110]...