Analysis Of The Status Of Interventional Therapy After Thrombolysis In STEMI Patients With Predicted FMC2W≥120min

Objective To investigate the cu rrent status,safety and short-term efficacy of interventional therapy within 2-24 hours after thrombolysis for STEMI patients,whose FMC2W≥120min in western Yunnan.And to provide reference for subsequent clinical treatment.Methods A total of 256 STEMI pati ents without thrombolytic contraindi cations and expected FMC2W≥120min who were referred to Che st pain center of the First Affi liated Hospital of Dal y University from 22 network hospitals in western Yunnan for treatment of PCI from September 2019 to November 2020 were retrospectively included,including 183 patients who were transferred to operation 2-24 hours after thrombolysis a nd 73 patients who wer e directly transferred to PCI.General da ta of all patients and related treatment data were collected,and t he general situation of intervention al therapy patients after thrombolysis transfer and the me eting of critical time points of treatment such as FMC 2N were analyzed,and the influencing factors of delay were analyzed for the significantly low meeting rate.According to the median post-thrombolysis angiogr aphy time(5h),the short-term efficacy of different tim ing of intervention after thrombolysis within 2-24 hours was analyzed.Meanwhile,in order to study the security and the short-term curative effect of interventional therapy after thrombolysis,we com pared the TIMI blood flow grade before operation and postoperative TIMI bloo d flow grade,left ventricular end-diastolic diameter,left ventricular ejection fraction,hospitalization days,hospitalizatio n expenses,incidence of bleeding,new heart failure and death during hospitalization between intervention treatment transfer aft er thrombolysis with direct PCI treatment.Results 1.There were 183 patients transported afte r thrombolysis included,whose age was(59.67±11.66)years old,with 147 males(80.3%).The firstgeneration Thrombolytic drugs were mainly used,95 cases(51.9%),and the total successful rate was 71.0%.There was a certain delay in the process from onset to thrombolytic therapy in STEMI p atients transported for intervention al treatment after thrombolysis,and the delay of FMC2 N was the most obvious,and the succ ess rate was only 38.3 %.The patients were further divided into the FMC2 N meeting group and the FMC2 N failing group for analysis,and there were no significant differences in age,gender,past history,S2 FMC time between the two groups(P> 0.05).However,t here were significant differences in FMC2 ECG,time from ECG to diagnosis,time from diagnosis to start of thrombolysis,time from signing of informed consent for thrombolysis,time from signing of informed consent for thrombolysis to start of thrombolysis and hospitals in diffe rent counties(P<0.05).2.There was no striking difference in gener al data between the early angiography group 2-5 hours after thrombolysis and the late angiography group 5-24 hours after thrombolysis,as well as in left ventricular end-diastolic diameter,left ventricular ejection fraction,incidence of new heart failure,bleeding and death events during hospitalization(P > 0.05).3.To compare and analyze the intervention treatment transfer after thrombolysis and direct PCI trea tment,there were no s ignificant differences in gender,age,past history,criminal blood vess el and S2FMC(P>0.05).Compared with direct transport PCI,although the S2 CAG of transshipment intervention group after thrombolysis longer(534(405,700)min vs.383(261,511)min,but its reperfusion treatment time significa ntly shortened(199(132,299)min vs.391(274,520)min,P=0.000).The percentage of grade 0 to 2 TIMI flow in the transshipment intervention group after thrombolysis significantly lower than the d irect PCI group(53.0% vs.86.3%,P=0.000),but there is no difference between the two groups in the postoperative TIMI flow level 3 percentage.There were no obvious differences between the two groups in hospitalization days,left ventricular end-diastolic diameter,left ventricular eje ction fraction,incidence of bleeding and new heart failure during hospitalization(P>0.05).H owever,in the transshipment intervention after thrombolysis group,the proportion of stent implantation was lesser (82.0% vs.93.2%,P=0.023),t he hospitalization cost was cheaper(2.70(2.41,305)ten-thousand-yuan vs.2.86(2.60,3.18)ten-thousand-yuan,P= 0.001),and the mortality rate was lower(3.3% vs.8.2%,P > 0.05).Conclusion The interventional therapy of thrombolytic transport for STEMI patients with estimated FMC2 W ≥ 120 min in western Yunn an is economical and effective,and deserves to be promoted vigorously,but there is still much room for improvement.