The application of intracoronary thrombolytic therapy during primary percutaneous coronary intervention in elderly patients with acute ST-segment elevation myocardial infarction / 中华老年医学杂志

ABSTRACT

Objective To evaluate the efficacy and safety of intracoronary thrombolysis during primary percutaneous coronary intervention(PCI)in elderly patients with acute ST segment elevation myocardial infarction(STEMI).Methods This prospective study was conducted at the Department of Cardiology of Shangqiu First People's Hospital.Elderly patients diagnosed with STEMI and undergoing primary PCI were consecutively recruited from September 2016 to September 2017.Of all recruited patients,106 patients were successfully followed up and were randomly divided into a treatment group(intracoronary thrombolysis group,n=54)and a control group (intracoronary saline group,n=52).Patients in the treatment group received an injection of 10 mg recombinant prourokinase (10 ml)via a balloon catheter while patients in the control group were injected with 10 mL saline instead.The incidences of slow flow,bleeding in 3 days after operation,left ventricular ejection fraction (LVEF),left ventricular end diastolic diameter(LVEDD),and major adverse cardiovascular events (MACE) in 90 days after operation were compared between the two groups.Results Compared with the control group,the treatment group had a decreased incidence of slow flow (x2 =4.06,P＜ 0.05).The incidence of bleeding in 3 days after operation showed no difference between the two groups(x2 =0.71,P＞0.05).The treatment group also had an elevated incidence of LVEF(t=-2.95,P ＜0.05)and a decreased incidence of LVEDD in 90 days after operation(t=2.86,P＜0.05),compared with the control group.No significant difference in the incidence of MACE in 90 days after operation was observed between the two groups(x2 =1.46,P＞0.05).Conclusions In elderly patients with STEMI,intracoronary thrombolysis during primary PCI can reduce the incidence of slow flow during operation,and improve the function and size of left ventricle without increasing the incidence of bleeding.