Impact Of Time From Dapt To Primary PCI And Administration With Gpi On Myocardial Reperfusion In Patients With STEMI

Objective: To explore a better solution of antiplatelet therapy before and during primary percutaneous coronary intervention(PCI)and to increase the rate of successful revascularization by comparing the effects of dual antiplatelet therapy(DAPT)at different time before PCI and administration with glycoprotein ?b/?a inhibitor(GPI)on myocardial reperfusion after primary PCI in patients with ST-segment elevation myocardial infarction(STEMI).Methods: This study enrolled a total of 302 STEMI patients undergoing primary PCI between February 2017 to February 2019.The patients were divided into group A(?60min,n=119),B(61?120min,n=99),C(121?180min,n=41)and D(>180min,n=43)four groups according to the time from DAPT to wire crossing(?T).And they were divided into GPI group(n=60)and non-GPI group(n=242)as well based on the fact that if they had received glycoprotein ?b/?a inhibitor or not.The baseline data,thrombolysis in myocardial infarction(TIMI)flow,the corrected TIMI frame count(c TFC),TIMI myocardial perfusion grading(TMPG),major adverse cardiovascular events(MACE)in hospital and bleeding complications of patients were collected and analyzed.Results: In the baseline data,compared with other groups,the total ischemic time of patients in group A and group B was shorter(207.61±137.26 vs.234.40±130.23 vs.336.88±187.70 vs.585.30±352.55,P <0.001)and the difference was significant.The proportion of ticagrelor in DAPT before primary PCI in group A was higher than other groups(67.2%vs.57.1% vs.52.4% vs.39.5,P=0.013),and the difference was significant.The proportion of administration with GPI in group A and group D was higher than other groups(26.1%vs.12.1%vs.14.6%vs.25.6%,P=0.043),and the difference was significant.The proportion of patients having a history of smoking ingroup B was higher than other groups(52.9%vs.65.7%vs.46.3%.41.9%,P=0.03),and the difference was significant.There was no significant difference in other baseline data among four groups.The rates of TIMI 3,TMPG ?2,the slow flow and no reflow of target vessel after PCI in four groups were different along with the difference of ?T,but the difference was not significant.There was no significant difference in the rates of MACE in hospital and bleeding complications among the four groups.In patients treated with GPI,compared with other groups,the rate of TIMI3 was higher when?T is between 121?180min(83.9% vs.41.7% vs.100.0% vs.63.6%,P = 0.014),and the rate of slow flow and no reflow after PCI was lower(25.8% vs.66.7%vs.0% vs.54.5%,P = 0.011),and the difference was significant.There was no significant difference among the groups in rates of TMPG? 2.In patients treated without GPI,there was no significant difference in the rates of TIMI 3,TMPG? 2 and slow flow and no reflow.Multivariate adjustment shows that,administration with GPI(OR0.342,95%CI 0.180-0.652,P=0.001)and thrombus aspiration(OR0.555,95%CI 0.309-0.996,P=0.048)are independent factors of slow flow and no reflow,administration with GPI(OR2.966,95%CI1.436-6.123,P=0.003)is independent factor of TIMI3,long total ischemic time(>288min)(OR0.602,95%CI 0.369-0.983,P=0.042)and having a history of smoking(OR0.590,95%CI 0.364-0.957,P=0.033)are independent factors of TMPG?2,long total ischemic time(>288min)(OR8.653,95%CI1.022-73.292,P=0.048)is independent factor of malign arrhythmia,low blood pressure(systolic blood pressure < 100 mm Hg)(OR0.173,95%CI0.034-0.886,P=0.035)is independent factor of cardiac death.Conclusion:DAPT at different time before primary PCI has no significant effect on the results of reperfusion and clinical events in hospital of patients with STEMI.Administration with GPI is a protective factor for successful reperfusion in patients with STEMI.And administration with GPI in patients with STEMI undergoing primary PCI may promote the rate of successful revascularization when the time from DAPT to wire crossing is between 121?180min.