A Comparative Study Of Clinical Efficacy Between Emergency And Elective PCI In Patients With STEMI After Spontaneous Recanalization

Objective:To compare the effect of emergency and elective coronary intervention on the prognosis of patients with ST-segment elevation myocardial infarction(STEMI)after Spontaneous Vascularization.Methods:This single-center mixed cohort analysis was performed on 273 STEMI patients after Spontaneous Recanalization,who was performed PCI and DES after hospitalized in the Second Affiliated Hospital of Nanchang University from January2010 to December 2019.All the patients were divided into Emergency PCI group(n=97 cases)and Elective PCI group(n=176 cases).General clinical baseline,examination,surgical treatment data of all the patients were collected,and patients were followed up 10 years.Then according to the thrombus load for subgroup analysis,divided into two groups: high thrombus burden group and low thrombus burden group.The study endpoints were all-cause death,cardiovascular death,heart failure,rehospitalization,recurrence of myocardial infarction,revascularization,the substitute endpoints were myocardial necrosis markers,ST-segment fall,echocardiography,TIMI blood flow and gastrointestinal hemorrhage.SPSS 25.0 software was used for statistical analysis,Kaplan-Meier survival curve was drawn to calculate the 2-year event-free survival rate,and Log Rank test was used to compare the survival rate of the two groups.Results:(1)From January 1,2010 to December 31,2019,a total of 7988 patients with acute myocardial infarction were screened in our hospital,and 2986 non-STEMI and non-surgery patients were excluded.5002 patients underwent emergency angiography.Among the STEMI patients undergoing PCI treatment,4587 cases did not meet the inclusion criteria,non-recanalization,and incomplete data collection.415 cases were eventually recanalized spontaneously.During the retrospective study,a total of 273 target populations were followed up.(2)There was no significant difference between the emergency PCI group(n=97)and elective PCI group(n=176)in age,male ratio,history of past illness,smoking history,hospitalized blood pressure,Killip classification,and the number of days in hospital(P>0.05).(3)Comparing the coronary angiography data of the two groups,it was found that there were no significant differences in infarction places,the location and number of vascular lesions,TIMI blood flow classification,and high thrombus burden(P>0.05).The preoperative TIMI blood flow classifications of the two groups were different(P<0.05),the emergency group was lower than the elective group.(4)Comparing the data of the two groups of patients,platelet count,D-2mer,ALT,fasting blood glucose,Blood lipids,creatinine,peak hypersensitivity troponin,peak creatine kinase,peak BNP,left ventricular ejection fraction,left ventricular end-diastolic diameter,left ventricular end-systolic diameter,and ST segment fall,there were no significant differences in them(P>0.05).Neutral/lymph is statistically different(P<0.05).(5)They were followed up for 10 years after discharge,with a median follow-up of 49 months.During the follow-up period,42 all-cause deaths and 31 cardiac deaths were recorded.Among them,13 cases died in the emergency group,8 cases died from cardiac death;29 cases died in the elective group,23 cases died from cardiac death.There were 32 cases in the emergency department,with a total event rate of 33%;in the elective group,59 cases,with a total event rate of 34%(P=0.49).The end-point events of the two groups of patients were compared.The two groups of patients suffered from cardiac death,heart failure,recurrence of myocardial infarction,stroke,gastrointestinal hemorrhage,and unplanned target vessel revascularization.The differences were not statistically significant(P>0.05);(6)Kaplan-Meier curve was drawn,and the 2-year event-free survival rates of patients in emergency group and elective PCI group were 86.6% and 83.5%,and the result of Log Rank test was P=0.92.The results suggesting that there should be no significant difference in the survival rates of patients treated with the two drugs.(7)Subgroup analysis: There were 12 cases of high thrombotic burden in the emergency group and 20 cases in the elective group,There was no significant difference in the incidence of high thrombotic burden between the two groups(P=0.85);2 cases of all-cause death in the emergency group and 1 case of all-cause death in the elective group,There was no significant difference(P=0.54).Cardiogenic death accounted for 1 case in the emergency group and 1 case in the elective group,There was no significant difference between the two groups(P=0.71);there was 1 case of heart failure in the emergency group and 1 case of heart failure in the elective group,There was no significant statistics in the two groups(P=0.63).There were 2 cases of recurrence of myocardial infarction in the emergency group and 1case in the elective group,There was no significant difference between the two groups(P=0.21).There was 1 case of gastrointestinal bleeding in the emergency group and 2cases in the elective group,There was no significant difference in incidence(P>0.05);(8)Age,N/L,low-density lipoprotein,and days in hospital may be related to the survival rate of patients in the survival-related multivariate logistic regression(P<0.05).Conclusion:There is no significant difference between Emergency PCI and Elective PCI combined with DES on the prognosis of STEMI patients with high thrombotic burden.