Clinical Study And Health Economics Evaluation Of Remote Ischemic Postconditioning To Improve The Prognosis Of Patients With STEMI

Objective:To study the effect of remote ischemic postconditioning(RIPost C)on the clinical prognosis of patients with ST-segment elevation myocardial infarction(STEMI)who received direct percutaneous coronary intervention(PCI)and to evaluate the health economics.Methods:A prospective study was conducted on 309 patients with STEMI diagnosed in the first affiliated Hospital of Xinjiang Medical University from February 2016 to October 2018.The patients were divided into two groups according to the random number table:the RIPost C group(n = 155)and the control group(n =154).Patients in RIPost C group completed three rounds of ischemic postconditioning of lower extremities before direct PCI.The area under creatine kinase isoenzyme(CK-MB),major adverse cardiac events(MACE)and direct medical expenses were compared between the two groups.The average out-of-hospital follow-up was 1.5 years.The incidence of out-of-hospital MACE and the direct medical expenses of re-admission were compared between the two groups.Results:The cumulative release of CK-MB within 48 hours after admission in the RIPost C group was lower than that in the control group [3757(1884～6209)IU vs 4085(2178～ 6698)IU,P< 0.05].The incidence of total MACE in the RIPost C group was lower than that in the control group(1.3% vs 9.1%,P< 0.05).The incidence of out-of-hospital total MACE in the RIPost C group was lower than that in the control group(18.7%vs 32.5%,P< 0.05),and the out-of-hospital mortality rate was lower than that in the control group(2.6% vs 7.8%,P< 0.05).The cumulative incidence of MACE events in the two groups was compared by Kaplan-Meier curve.The results showed that the Kaplan-Meier curve was significantly separated 50 days after PCI,and the cumulative incidence of out-of-hospital total MACE in the RIPost C group was lower than that in the control group(P< 0.05).The direct medical expenses during hospitalization and re-admission in the RIPost C group were lower than those in the control group,which were [53579(48214 ～ 62375)yuan vs 57805(48155 ～ 70011)yuan,P<0.05] and [5288(0 ～ 20906)yuan vs 12949(5170 ～ 40000)yuan,P<0.05 ],respectively.Conclusion: As an adjuvant therapy for PCI in patients with STEMI,RIPost C can not only reduce the extent of myocardial injury,improve the long-term prognosis,but also reduce the economic burden caused by STEMI.