ABSTRACT
Objective To investigate the differences in clinical efficacy and safety between thrombolysis followed PCI (percutaneous coronary intervention) and primary PCI in patients with acute STEMI (ST elevation myocardial infarction). Methods A total of 215 STEMI patients who visit our clinic within 12 h since onset of their symptoms from May 2013 to January 2015 were enrolled. All eligible patients were divided into Early PCI group(n=68) and pPCI group (n=147) based on whether or not they received injection of recombinant human prourokinase thrombolytic therapy before their visit. Immediate TIMI (Thrombolysis In Myocardial Infarction) flow grade of infarct-related artery (IRA) before and after PCI treatment, post?operative CTFC (Corrected TIMI Frame Count) and TMPG (TIMI myocardial perfusion grade) were compared between these two groups. The incidence of bleeding during hospital stay , left ventricular function at 6 month after intervention and major adverse cardiac events (MACE) were all observed. Rusults There is no obvious difference between the baseline of two groups. Before PCI, the proportion of TIMI grade 2-3 was higher in Early PCI group (77.9%vs 20.4%,P0.05). CTFC and peak value of serum CK-MB were lower [(27.7 ± 5.0) vs (32.6 ± 7.1), P<0.05;(225.8 ± 108.3) U/L vs (283.4 ± 110.6) U/L, P<0.05] and rate of TMPG 3 is higher (82.4%vs 68.7%, P<0.05)in Early PCI group than those in pPCI group. No significant difference was found in the incidence of bleeding and MACE during hospital stay and Left ventric?ular function at 6 months after operation between these two groups. By contrast, LVEFs were higher while LVEDds (LVED diameter) were lower after 3 and 6 months of the intervention compared to those before intervention in both groups (P <0.05). Conclusion It is a safe and effective reperfusion strategy for STEMI patients to receive rhPro-UK thrombolytic thera?py followed early PCI as an alternative way to those who failed to receive pPCI on time. It didn′t increase the occurrence of bleeding complications and MACE, and at the same time it presented the same benefit in improving recent cardiac function as pPCI did.
ABSTRACT
Objective To assess the therapeutic effects of Yiqifumai combined with Alprostadil injection on patients with chronic cardiac insufficiency and angina pectoris.Methods One hundred and fifty patients with heart dysfunction (NYHA [Ⅱ-Ⅲ) and angina pectoris were randomly divided into three groups,the control group (n=50),the Yiqifumai group (n=50),and the Yiqifumai plus Alprostadil group (n=50).Parameters including clinical effectiveness,electrocardiograph (ECG),heart function and hemodynamics were evaluated.Results The overall clinical effectiveness rate in the Yiqifumai plus Alprostadil group (94 ％) was higher than those in the Yiqifumai group (78 ％) and the control group (54％) (P＜0.05 for both).The overall effectiveness rate in ECG changes was higher in the Yiqifumai plus Alprostadil group (84％) than in the Yiqifunai group (58％) and the control group (42％) (P＜0.05 for both).While no significant difference in the left ventricular ejection fraction (LVEF) was found among the three groups before treatment,evident improvement in LVEF was observed in the Yiqifunai group and the Yiqifumai plus Alprostadil group 14 days after treatment,compared with pre-treatment data [(49±9)％ vs.(40±10)％ and (59±9)％ vs.(41±10) ％,respectively; P＜0.05 for both].However,there was no significant difference between the two groups (P＞0.05).There was no improvement in LVEF in the control group after treatment (P ＞0.05).No difference in hemodynamic parameters,including cardiac output,cardiac index and left ventricular stroke work index,was found among the three groups before treatment (P＞0.05),but they showed improvement in the Yiqifunai group and the Yiqifumai plus Alprostadil group after treatment (P＜0.05 for both),with greater improvement in the latter group.The improvement was not significant in the control group before and after treatment (P＞0.05).Conclusions Yiqifumai combined with Alprostadil in the treatment of cardiac insufficiency with unstable angina pectoris has advantages in improving clinical symptoms,heart function and hemodynamics.