Abstract:

Objective To explore the value of pre-hospital heparinization combined with one pack of drugs(Aspirin enteric-coated tablets 300 mg, Clopidogrel 300 mg, Atorvastatin tablets 40 mg) in patients with acute ST-segment elevation myocardial infarction (STEMI) underwent primary percutaneous coronary intervention (PPCI).Methods Totally 77 patients with acute STEMI who underwent PPCI in our hospital from June 2021 to August 2022 were enrolled as subjects. All subjects were allocated to observation group ( n=21) and control group ( n=56) according to the pre-hospital and in-hospital heparinization combined with one package of drugs. In the observation group, after being diagnosed as STEMI by the Chest Pain Center via contacting WeChat Group, the patient was intravenously injected with 5,000 U of ordinary heparin in combination with one pack of drugs immediately. In the control group, after the patient came to the emergency department of our hospital and diagnosed as STEMI, the patient was given 5,000 U of unfractionated heparin (UFH) combined with one pack of drugs, and immediately started PPCI in the catheter room. The baseline characteristics, immediate coronary angiography, serological indicators, major postoperative cardiovascular adverse events and reflow status in the thrombolysis in myocardial infarction (TIMI) test were compared between the two groups. Results There were no significant differences in gender, age, hypertension, diabetes, hyperlipidemia, symptom onset time and other baseline data between the two groups ( P>0.05). There was no significant difference between the two groups in left descending artery (LAD), left circumflex artery(LCX), right coronary artery(RCA) and other infarction related artery (IRA) and TIMI2 grade ( P>0.05),TIMI grades 0~1 and 3 were compared, and the difference was statistically significant ( P<0.05). Postoperative values of creatine kinase MB (CK-MB), platelet / lymphocyte ratio(PLR) and monocyte / high-density lipoprotein cholesterol (HDL-C) ratio (MHR) in both groups were obviously lower than those before surgery, and the observation group was significantly lower than the control group ( P<0.05). There were no significant differences in the probability of postoperative cardiac death, heart failure, stroke, recurrent angina, and revascularization between the two groups ( P>0.05). However, the probability of bleeding in the observation group was significantly lower than that in the control group ( P<0.05).The postoperative no-reflow rate in the control group was 19.6%, and there was no no-reflow in the observation group, indicating the no-reflow rate in the control group was significantly higher than the observation group ( P<0.05).Conclusion The application of pre hospital heparin combined with one pack of drugs in patients with STEMI can not only effectively improve the revascularization rate of IRA, improve myocardial perfusion and serological indicators, but also significantly reduce the incidence of postoperative no-reflow and cardiovascular adverse events, improve prognosis and promote recovery.

Key words: ST-segment elevation myocardial infarction(STEMI), percutaneous coronary intervention(PCI), heparin, one pack of drugs, emergency medical service