| Objective:To evaluate the effect of sacubitril/valsartan combined with percutaneous coronary intervention(PCI)after thrombolysis or primary PCI in patients with acute ST-segment elevation myocardial infarction(STEMI).To provide a basis for the choice of reperfusion treatment strategy and the preventive treatment of heart failure after PCI in patients with acute ST-segment elevation myocardial infarction.Methods:A total of 160 patients with acute ST-segment elevation myocardial infarction treated in the Department of Cardiology of the First Affiliated Hospital of Dali University from May 2021 to June 2022 were selected by random sampling method.According to whether the time from the first medical contact to the guide wire passing through the infarct-related vessel was more than 120 minutes,the patients were divided into the post-thrombolysis PCI group(85 cases)and the primary PCI group(75 cases).Sacubitril/valsartan was used to prevent heart failure after hemodynamic stabilization in both primary PCI group and thrombolysis followed by PCI group.The age,past history,coronary artery disease,surgical intervention related data,coronary microcirculation indicators of the two groups of patients were recorded.The drug use,cardiac function,cardiac remodeling changes and adverse cardiovascular events were followed up before and after treatment.Results:1.A total of 160 patients with acute ST-segment elevation myocardial infarction were enrolled in this study,with 85 patients in the thrombolysis PCI group and 75 patients in the primary PCI group.There were no significant differences in general data and cardiac function at admission between the two groups(P>0.05).2.In this study,the coronary artery lesions were mainly single vessel lesions,and 76 cases occurred,accounting for 46%.The diseased vessels were mainly left anterior descending artery(109 cases,68%).Among them,the infarct-related vessel in PCI patients after thrombolysis was mainly the left anterior descending artery(74.1%).There were no significant differences in the number of diseased coronary vessels and infarct-related vessels between the two groups(P>0.05).3.FMC to W time(360.5(229.0,411.0)vs.117.9(58.0,214.0),P<0.05);There were no significant differences in ischemic time and D to W time between PCI group and primary PCI group after thrombolysis(P>0.05).4.The proportion of patients with poor ST segment resolution at 2 hours after PCI was 75.0% in the thrombolysis group and 25.0% in the primary PCI group.The STR after PCI in the primary PCI group was better than that in the thrombolysis PCI group,and the difference was statistically significant(P<0.05).Pearson correlation analysis showed that STR was positively correlated with LVEF at 6 months after treatment(r =0.176,P<0.05).The AMR of the two groups were(256.61±60.06)vs.(276.77±64.24),and the AMR of the primary PCI group was higher than that of the PCI group after thrombolysis,and the difference was statistically significant(P<0.05)5.After treatment,there was no significant difference in the prevalence rate between the two groups according to the NYHA cardiac function classification(P>0.05);In both groups,NT-pro BNP was improved after treatment(P< 0.05);There was no significant difference in NT-pro BNP between the two groups before and after treatment(P> 0.05).6.After 6 months of treatment,LVEDD and LVESD in the direct PCI group were better than those in the PCI group after thrombolysis,and the differences were statistically significant(P<0.05);There were no significant differences in LVEF and LAD between the two groups(P>0.05).7.There were no significant differences in the levels of uric acid and serum potassium between the two groups before and after treatment(P>0.05).The creatinine level at 3 months and 6 months after PCI was higher than that at admission,and the difference was statistically significant(P<0.05),but still at a normal level.8.Here were 32 cases of MACEs at the end of follow-up,and the difference was not statistically significant(P>0.05).MACEs were mainly heart failure in both groups,with an incidence of 7.5%.9.In 65 years old patients,LVEF and LVEDD in the primary PCI group were better than those in the thrombolysis PCI group at 6 months after treatment(P<0.05).10.After 6 months of follow-up,only 2 patients(1.3%)reached the target dose of200 mg bid,and 158 patients(98.7%)did not reach the target dose.The incidence of LVEF ≤ 50% was higher in the maintenance-dose group(23.6%)than in the increased-dose group 8.1%(P<0.05).Conclusions:1.Compared with primary PCI,PCI after thrombolysis has no significant difference in the prognosis of STEMI patients.It does not increase the incidence of adverse cardiovascular events,and reduces the level of AMR and improves myocardial coronary microcirculation perfusion.Therefore,PCI after thrombolysis is recommended as the preferred reperfusion strategy for patients with STEMI in primary hospitals where primary PCI is not possible and the estimated time from the first medical contact to the passage of the guide wire in the infarct-related vessel is more than 120 minutes.2.On the basis of routine secondary prevention after PCI,early application of sacubitril/valsartan can improve left ventricular systolic function and delay ventricular remodeling. |
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