Study On The Correlation Between TIMI Risk Index And Unfractionated Heparin Anticoagulant Compliance In PCI Patients With STEMI

Objective To explore the correlation between the TIMI(the thrombolysis in myocardial infarction)risk index and anticoagulant compliance with UFH(unfractionated heparin)during PCI(percutaneous coronary intervention)in STEMI(ST-segment elevation myocardial infarction)patients.To analyze the predictive value of TIMI risk index on HR(heparin resistance),and to further explore the risk factors affecting heparin anti-coagulation during PCI in STEMI patients.Methods Patients who underwent PCI and underwent UFH anti-coagulation in Inner Mongolia Autonomous Region People’s Hospital for STEMI from December 2019 to November 2020 were selected.Based on the TIMI risk index,all patients were divided into three groups:0-3,low risk group;Score of 4-6,middle risk group;Score not less than 7,high risk group;Each group included 40 consecutive patients,a total of 120 patients.Patients were treated with 100U/kg UFH before operation.ACT(Activated clotting/coagulation time)was measured at 30 minutes after UCH.General clinical data(e.g.age,gender,heart rate,systolic blood pressure,diastolic blood pressure,body weight,PLT(platelets),hs-CRP(hypersensitive C reactive proteadministrationin),APTT(activated partial thromboplastin time),FIB(fibrinogen),smoking history,past medical history,etc)were collected.To analyze the correlation between TIMI risk index and heparin resistance,and observe adverse events(death or ischemic recurrence)occurring within 30 days after PCI in all three groups.To summarize the predictive value of TIMI risk index on heparin resistance,and to analyze the risk factors affecting heparin anti-coagulation during PCI in STEMI patients by regression analysis.Results 1.At 30 minutes of intraoperative UFH administration in PCI,ACT measurements in the low-risk group were 345.18±88.86s,The anticoagulant compliance rate for unfractionated heparin was 92.5%.The ACT measurement in the middle-risk group was 319.35±78.94s,Compliance rate was 82.5%.The ACT measurement in the high-risk group was 273.10±73.44s,the rate was only 50%.By pairedly comparing ACT measurements and compliance rate(ACT≥ 250s)among three groups,there was statistical difference between high risk group and middle and risk group,and between high and low risk one either(P<0.05).But there was no significant difference between the middle and the low risk group(p>0.05).2.Adverse events within 30 days after PCI:no death outcome occurred in all three groups.There were 10 cases(25%),3 cases(7.5%)and 2 cases(5%)in high,middle and low risk groups,respectively.The ischemic recurrence rate was statistically different(x 2=8.686,P=0.013).Statistical analysis showed that the number of ischemic cases in the high-risk group was higher than that in the other two groups(χ2=6.275、P=0.012;χ2=4.501、P=0.034).Although the number of ischemic cases in the middle risk group was slightly higher than that in the low risk group,there was no statistical difference between the two groups(χ2=0.213、P=0.644).3.In three groups totaled 120 STEMI patients who underwent PCI,90 cases reached the standard of heparin anti-coagulation and 30 cases did not reach the standard.Analysis of correlation between PCI heparin anticoagulant compliance and baseline data showed that,there were significant differences between the compliance and noncompliance in TIMI risk scores,intra-score indexs(killip grade and left bundle branch block)and level of PLT,hs-CRP and FIB(P<0.05).Multivariate logistic regression analysis found that TIMI high risk score,killip grade 2,high PLT count,high hs-CRP level and high FIB level were risk factors for heparin anticoagulant resistance during PCI(P<0.05).Conclusion 1.Among STEMI patients who underwent PCI,ACT measurements and attainment rates were significantly lower in the high-risk group of TIMI scores,postoperative ischemic events are significantly increased in high-risk group,either.The TIMI score can assist in determining intraoperative heparin resistance and potential risk of postoperative adverse events(especially ischemic recurrence).2.In addition to the known risk factor of low AT-Ⅲ activity level,TIMI high-risk index,high killip grade,high PLT count,high hs-CRP level and high FIB level were also risk factors for heparin resistance during PCI.3.For the TIMI high-risk index,patients with killip grade II or above,high PLT counts,high hs-CRP level and high FIB level may be considered for increased heparin dosage during PCI or for switching to drugs with other anticoagulant mechanisms(e.g.Bivarutin,Sodium sulfonamide,Tirofiban).After operation,the duration of dual anti-platelet therapy can be prolonged or triple anti-platelet treatment can be given directly.