Analysis Of Factors Influencing Thrombolytic Effect Of Recombinant Human Prourokinase In Acute St-segment Elevation Myocardial Infarction

Objective: To analyze the factors influencing the efficacy of intravenous thrombolysis of rh Pro-UK in patients with STEMI.Methods:A total of 84 STEMI patients treated with rh Pro-UK thrombolytic therapy in primary hospitals in the CPC of the second hospital of Hebei medical university from June 2019 to December 2019 were retrospectively analyzed.According to whether the IRA were opened or not after intravenous thrombolysis,they were divided into the open group(65 cases)and the non-opened group(19 cases).Comparing the general clinical data of patients,two groups of gender,age,surface area,whether concomitant hypertension,diabetes,hyperlipemia,BMI,hyperlipidemia,cerebral infarction,whether for anterior wall myocardial infarction,Killip classification,on admission creatinine values,systolic blood pressure,diastolic blood pressure,heart rate,LDL-C,and platelet aggregation rate,APTT.The parameters related to reperfusion therapy in the two groups were compared: first diagnosis hospital,chest pain to FMC,infarction-related vascular sites,single-vessel/ multi-vessel lesions,thrombus aspiration,intra-coronary administration(Tirofiban?rh-Pro UK),and stent implantation.The parameters related to the inpatient treatment in the two groups were compared: CK peak,CK-MB peak,LVEF,MACE,bleeding enents,heart failure,malignant arrhythmia,in-hospital mortality,average length of stay.Logistic regression was used to analyze the factors affecting the thrombolytic effect of rh Pro-UK in STEMI patients.Results:Of the 84 patients with STEMI thrombolytic therapy,65 were successfully opened and 19 were not,with the recanalized rate of 77.38%.There were no statistically significant differences in gender,age,BMI,body surface area,previous hypertension,hyperlipidemia,history of cerebral infarction,anterior wall myocardial infarction,creatinine value,systolic blood pressure,LDL-C,and platelet aggregation rate at admission among the two groups.Compared with the opened group,the prevalence of diabetes in the unopened group was higher(42.10% vs 12.30%,P=0.004).The proportion of patients with heart failure grade ? grade II in the non-opened group at admission was higher than that in the opened group(42.10% vs 15.38%,P=0.023).After thrombolysis,APTT in non-opened group was lower than that in the opened group(38.95±16.11 s vs 53.25±30.64 s,P=0.001).In addition,the heart rate and diastolic blood pressure of the patients in the non-open group were lower.Reperfusion parameters were compared between the two groups,among which there was no statistically significant difference between the infarction-related vascular sites and the single-branch or multi-branch lesions between the two groups.The proportion of patients first diagnosed in the in CPC the non-opened group was significantly lower than that in the opened group(P=0.002).Moreover,the time of chest pain-FMC in patients of non-opened group was significantly longer than that in patients of opened group(P=0.014).When patients in the non-opened group were transferred to the hospital for reperfusion treatment,the number of patients receiving thrombolytic recanalization was significantly higher than that in the opened group(P=0.000),the proportion of thrombus aspiration(P=0.017),and the number of patients receiving stent implantation(P=0.010)were significantly higher than that in the opened group.The condition of infarction-related vascular flow after interventional treatment was worse in the non-opened group than that in the opened group(P=0.038).During hospitalization,the proportion of MACE events and heart failure in non-opened group was significantly higher than that in opened group.There was no significant difference between the two groups in CK peak,CK-MB peak,LVEF,bleeding enents,malignant arrhyhtmia,in-hospital mortality,and average length of stay.Multivariate Logistic regression analysis showed that whether the first diagnosis of STEMI patients was CPC was an independent risk factor for thrombolytic recanalization(P=0.018).Conclusions:1.For patients with STEMI,the first choice is to visit the hospital that have established CPC,which can shorten reperfusion time and improve thrombolytic efficiency.2.STEMI patients with diabetes,delayed visit time,and low anticoagulant strength all lead to poor thrombolytic effect,and more severe disease,with a higher proportion of severe heart failure.