| Objective To explore the relationship between circ MICRA and mi R-150 and the prognosis of patients with STEMI,to clarify the impact of post thrombolytic PCI and primary PCI on the prognosis of patients with STEMI,and provide reference for clinical decision-making from a molecular point of view.Methods From June 2021 to January 2022,39 patients with acute ST segment elevation myocardial infarction（STEMI）who were first treated in the Emergency Department of the first affiliated Hospital of Dali University or transferred directly from the grass-roots hospital to the first affiliated Hospital of Dali University and were treated with primary PCI within 12 hours were selected as primary PCI group.In addition,35 STEMI patients who were first diagnosed in the grass-roots hospital which could not undergo primary PCI and received intravenous thrombolytic therapy were transferred to the first affiliated Hospital of Dali University and undergo primary PCI within 24 hours as the PCI after thrombolysis group.In addition,30 healthy volunteers who went to the physical examination center of the first affiliated Hospital of Dali University in the same period were selected as the healthy control group.General data of all subjects and relevant data of STEMI patients during hospitalization and follow-up 3 months after discharge were collected to analysis the TIMI blood flow grade before and after operation,length of stay in hospital,Cardiac function indicators,new heart failure and adverse events during hospitalization and 3months after discharge in primary PCI group and PCI after thrombolysis group,to compare the safety and effectiveness of the two treatment strategies.Detecting the circ MICRA and mi R-150 expression levels in peripheral blood of all subjects by real-time quantitative polymerase chain reaction（RT-PCR）,Statistical analysis was used to analyze the difference of its expression levels between STEMI group and normal control group,between primary PCI group and PCI after thrombolysis group,and between heart failure after AMI group and non-heart failure after AMI group.Pearson correlation analysis was used to study the correlation between the expression level of circ MICRA and mi R-150 and left ventricular dysfunction.Result 1.There was no significant difference in postoperative TIMI blood flow,length of stay in hospital,left ventricular ejection fraction,left ventricular systolic and end-diastolic diameter between PCI after thrombolysis group and primary PCI group（P > 0.05）,there was significant difference in TIMI blood flow before operation（P <0.05）.There was no significant difference in the indexes of cardiac function,new heart failure and the incidence of adverse events between the two groups during hospitalization and 3 months after discharge（P>0.05）.2.The expression levels of circ MICRA and mi R-150 in STEMI group were significantly lower than those in healthy control group（P<0.05）.There was no significant difference in the expression of circ MICRA between the PCI after thrombolysis group and the primary PCI group（P > 0.05）.the expression level of mi R-150 in the PCI after thrombolysis group was significantly lower than that in the primary PCI group（P<0.05）.There was no significant difference in the expression of circ MICRA between the heart failure after AMI group and the non-heart failure after AMI group（P > 0.05）.The expression level of mi R-150 in heart failure after AMI group was significantly lower than that in non-heart failure after AMI group（P<0.05）.Through Pearson correlation analysis,it was found that there was a negative correlation between circ MICRA and left ventricular end-diastolic volume（r =-0.261,P < 0.05）,There was a positive correlation between mi R-150 and left ventricular ejection fraction（r = 0.231,P < 0.05）.and a positive correlation between circ MICRA and mi R-150（r = 0.344,P < 0.05）.Conclusion The STEMI patients who accept PCI after thrombolysis does not increase the risk of adverse events such as death during hospitalization and within 3 months after discharge.It is suitable for China’s national conditions.It is a suitable reperfusion strategy for STEMI patients who are expected to have more than 120 minutes from the first medical contact time to the guide wire passage time.However,compared with primary PCI,the two treatment strategies have no significant difference in the prognosis of STEMI patients.circ MICRA and mi R-150 are closely related to left ventricular dysfunction after AMI.Among them,mi R-150 may be more valuable than circ MICRA in predicting the occurrence of HF after AMI. |
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