Effects of thrombolytic therapy time on serum inflammatory factor, cathepsin S, connective tissue growth factor and left ventricular ejection fraction in patients with acute ST-elevation myocardial infarction / 中国基层医药

ABSTRACT

Objective:To investigate the effects of thrombolytic therapy time on serum inflammatory factors, cathepsin S, connective tissue growth factor (CTGF), left ventricular ejection fraction (LVEF) and left ventricular end diastolic diameter (LVEDD) in patients with acute ST-elevation myocardial infarction.Methods:The clinical data of 119 patients with acute ST-elevation myocardial infarction who received thrombolytic therapy in the People's Hospital of Taierzhuang District of Zaozhuang from January 2019 to May 2020 were retrospectively analyzed. These patients were assigned to three groups according to different time points at which thrombolytic therapy was performed group A (the time from onset to thrombolytic therapy ≤ 3 hours, n = 27), group B (3 hours < the time from onset to thrombolytic therapy ≤ 6 hours, n = 39), group C (6 hours < the time from onset to thrombolytic therapy ≤ 12 hours, n = 53). Recanalization rate, recanalization time, ST segment resolution rate at 2 and 12 hours, serum levels of inflammatory factors [including interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) and high-sensitivity C-reactive protein (hs-CRP)], cathepsin S, CTGF, LVEF, and LVEDD, and incidence of cardiovascular adverse events. Results:Recanalization time in group C was (148.73 ± 15.37) minutes, which was significantly longer than that in groups A and B [(89.34 ± 8.95) minutes, (98.76 ± 9.33) minutes]. Recanalization rate and ST segment resolution rate at 2 and 12 hours in group C were 45.28%, (40.17 ± 4.77) %, (73.92 ± 8.24) %, respectively, which were significantly lower than those in the groups A and B [96.30%, 79.49%, (47.42 ± 5.12)%; (83.68 ± 9.33)%, (43.56 ± 4.87)%, (78.73 ± 8.44)%] ( t/ χ2 = 248.088, 4.244, 20.204, 11.146, 18.508, 19.861, 6.271, 4.789, 17.995, 10.932, 3.339, 4.111, 4.100, 3.828, 3.100, 2.244, all P < 0.05). At 2 and 12 hours after thrombolytic therapy, IL-6, TNF-α and hs-CRP levels in group C were (23.29 ± 2.12) ng/L, (27.03 ± 2.75) ng/L, (6.49 ± 2.37) mg/L, (22.73 ± 2.05) ng/L, (26.24 ± 2.37) ng/L and (6.01 ± 2.53) mg/L, respectively, which were significantly higher than those in groups A and B ( t = 54.578, 54.578, 10.638, 8.584, 8.735, 5.199, 7.909, 7.171, 3.597, 1.382, 1.584, 1.008, 7.237, 5.190, 4.364, 8.829, 11.114, 2.585, 3.172, 6.815, 2.196, all P < 0.05). At 2 and 12 hours after thrombolytic therapy, cathepsin S and CTGF levels in group C were (29.97 ± 3.98) μg/L, (30.03 ± 4.79) μg/L, (28.05 ± 2.13) μg/L, (28.29 ± 4.31) μg/L, respectively, which were significantly higher than those in groups A and B [(31.74 ± 3.56) μg/L, (29.87 ± 4.91) μg/L; (20.81 ± 2.35) μg/L, (16.94 ± 3.46) μg/L; (30.95 ± 3.79) μg/L, (29.93 ± 4.95) μg/L; (26.37 ± 2.44) μg/L, (21.46 ± 4.79) μg/L, t = 93.870, 68.555, 15.039, 12.562, 6.345, 7.679, 3.096, 1.966, 13.882, 3.514, 11.863, 7.164, 9.239, 4.199, all P < 0.05). At 2 and 12 hours after thrombolytic therapy, LVEF and LVEDD in group C were (42.81 ± 4.77)%, (52.64 ± 4.71) mm, (43.13 ± 5.11)%, (51.57 ± 4.01) mm, respectively, which were significantly lower than those in groups A and B [(42.61 ± 4.58)%, (52.31 ± 4.47) mm, (46.33 ± 4.35)%, (47.75 ± 3.41) mm, (42.73 ± 4.79)%, (52.79 ± 4.76) mm, (44.79 ± 4.44)%, (49.93 ± 3.73) mm, t = 4.285, 9.193, 3.060, 4.214, 1.970, 2.953, 0.333, 1.259, 2.779, 1.626, 4.229, 1.996, 1.404, 2.416, all P < 0.05). The total incidence of cardiovascular adverse events was 7.41%, 12.82% and 33.96% in groups A, B and C, respectively ( χ2 = 4.383, all P < 0.05). Conclusion:The earlier the thrombolytic therapy time after acute ST-elevation myocardial infarction, the higher the recanalization rate and ST segment resolution rate, the milder the inflammatory reaction, atherosclerosis, the better the cardiac remodeling, the better the recovery of cardiac function, and the lower the incidence of cardiovascular adverse events.