| Objective:Percutaneous coronary intervention(PCI)is the main method for the treatment of acute ST-segment elevation myocardial infarction(STEMI).However,the incidence of no-reflow/coronary slow flow(NR/CSF)phenomenon is still high after surgery,which seriously affects the clinical benefit of patients.In recent years,studies have found that rh Pro-UK has the characteristics of low bleeding risk and high success rate in opening infarction vessels,but there is limited evidence-based medicine to explore the safety and effectiveness of the targeted application of rh Pro-UK in the coronary arteries.This study retrospectively analyzed the effect of intra-coronary targeted application of rh Pro-UK on NR/CSF in patients with high thrombotic load STEMI during emergency PCI,in order to provide a relatively objective clinical basis for the reasonable choice of treatment options for STEMI patients with high thrombus burden.Method:From December 2018 to June 2020,266 STEMI patients with high thrombus burden who met the inclusion and exclusion criteria underwent emergency PCI,Selected for treatment in the cardiovascular department of our hospital.They were divided into three groups,according to whether rh Pro-UK was used during the operation and the different dosages used.There were 96 cases in the simple thrombus aspiration group;82 cases in the PUK10 mg group(10mg rh Pro-UK was applied in the coronary artery after thrombus aspiration).88 cases in the PUK20 mg group(20mg rh Pro-UK was applied in the coronary artery after thrombus aspiration);we collect,record and analyze the three groups of patient’s general clinical baseline data,mainly including(1)age,body mass index(BMI),blood pressure,past medical history,laboratory blood biochemical tests,Color doppler echocardiography results within 48 hours after admission,coronary artery disease,interventional treatment,and coronary angiography images;(2)Compare and analyze the myocardial perfusionhree of the three groups of patients,including TIMI blood flow classification,the incidence of no-reflow/coronary slow flow and corrected TIMI frame count;(3)Compare the three groups of patients with preoperative and postoperative blood urea nitrogen(BUN),uric acid(UA),serum creatinine(Cr)and hemoglobin(Hb);(4)Comparison of major adverse cardiovascular events(MACE)(including cardiac death,recurrent myocardial infarction,heart failure and malignant arrhythmia)during hospitalization of the three groups of patients,Bleeding events during hospitalization and 6 months MACE events after discharge.(5)Multivariate logistic regression analysis was used to evaluate the influencing factors of no-reflow/coronary slow flow in STEMI patients with high thrombus burden.Results:1、A total of 266 patients were included in this study.The three groups were mostly male patients,73 patients(76.04%)in the simple thrombus aspiration group,65 patients(79.27%)in the PUK10 mg group,and 66 patients(75%)in the PUK20 mg group;The general clinical measurement data of patients showed that the left ventricular diameter(LV)was statistically difference between the three groups(P=0.003),comparing the three groups in pairs,there was a statistically difference between the PUK10 mg group and the simple TA group,P<0.05;Between the PUK20 mg and the TA group there was a statistically difference,P<0.05.2、 There was no significant difference in clinical data such as intra-operative puncture path,myocardial bridge,coronary artery lesion,criminal blood vessel,and number of implanted stents among the three groups of patients(P>0.05).There was no significant difference between the three groups using temporary pacemaker,intra-aortic balloon pump(IABP),extracorporeal membrane oxygenation(ECMO)and other auxiliary devices during the operation(P>0.05).3、Comparison of the three group’s postoperative TIMI flow grades.In the simple thrombus aspiration group,82 cases(85.42%)of TIMI blood flow were grade 3,and14 cases of TIMI blood flow were grade 0-2(14.58%);PUK10mg group,77 cases(93.9%)of grade 3,5 cases of TIMI blood flow 0-2(6.1%);In the PUK20 mg group,84 cases of TIMI blood flow 3(95.45%),4 cases of TIMI blood flow 0-2(4.55%);The difference between the three groups was statistically significant(P=0.033).Compared with TIMI blood flow level 0-2,there was a statistical difference between the PUK20 mg group and the simple thrombus aspiration group(P<0.05).The incidence of no-reflow/coronary slow flow in the PUK20 mg group was lower;Although there was no significant difference between the PUK10 mg group and the simple thrombus aspiration group(P>0.05),the patients with no-reflow/coronary slow flow in the PUK10 mg group were lower than those of the simple thrombus aspiration group;there was no significant statistical difference between the PUK10 mg group and the PUK20 mg group(P>0.05);4 、 Comparison of CTFC counts among the three groups of patients: simple thrombus aspiration group(27.23±3.13)frames,PUK10 mg group(25.25±3.01)frames,PUK20 mg group(22.59±2.83)frames,the difference between the three groups was statistically significant(P=0.001);Pairwise comparison,the PUK10 mg group and the pure thrombus aspiration group are statistically different,P<0.05,the difference between the PUK20 mg group and the pure thrombus aspiration group is significant(P<0.05);the difference between PUK20 mg group and PUK 10 mg group was statistically significant(P<0.05);the CTFC of the PUK10 mg group and the PUK20 mg group were lower than those of the simple thrombus aspiration group.5 、 There was no significant difference between the three groups of bleeding events during hospitalization,MACE during hospitalization,and 6 months MACE after discharge(P>0.05);6、 Comparison of BUN,UA,Cr,eGFR and Hb levels of the three groups of patients: The postoperative eGFR levels of the simple thrombus aspiration group,PUK10 mg group and PUK20 mg group were statistically different,P=0.022,pairwise comparison,There was a statistical difference between the PUK10 mg group and the pure thrombus aspiration group(P<0.05);the postoperative UA and Hb levels of the three groups showed a downward trend,and there was a statistical difference compared with preoperatively(P<0.05);the BUN of PUK10 mg group and the PUK20 mg group after surgery was statistically significant compared with preoperative(P<0.05)7、Multivariate logistic regression analysis showed that the targeted application of20 mg dose of rh Pro-UK in the coronary artery is an independent protective factor for no-reflow/coronary slow flow phenomenon,and stroke is an independent risk factor for no-reflow/coronary slow flow phenomenon.Conclusions: 1 、 In patients with high thrombus burden STEMI undergoing emergency PCI treatment,intracoronary targeted application of rh Pro-UK can significantly improve coronary microcirculation,increase myocardial perfusion level,and reduce no-reflow/coronary slow flow compared with simple thrombus aspiration.The 20 mg dose of rh Pro-UK has better effect.2、Targeted application of rh Pro-UK 10 mg and rh Pro-UK 20 mg in the coronary artery during emergency PCI does not increase the incidence of MACE and bleeding events,and has little effect on postoperative renal function.It is safe for STEMI patients with high thrombus burden.3、Intracoronary targeted application of rh Pro-UK 20 mg is an independent protective factor for no-reflow/coronary slow flow phenomenon,stroke history is an independent risk factor for no-reflow/coronary slow flow phenomenon. |
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