The clinical study of facilitated PCI in ST-segment elevation acute myocardial infarction

Objective: To evaluate the efficacy and safety of facilitated PCI (low-dose rt-PA combined with immediate planned rescue percutaneous coronary intervention) in ST-segment elevation acute myocardial infarction (STEMI). Methods: Two hundred and fifteen patients with STEMI were divided into direct PCI group (n=150) and facilitated PCI group (n=65). The patients in direct PCI group were under angiography without thrombolysis, while the patients in facilitated PCI group were under an intravenous drip of 50 mg rt-PA during 30 minutes before PCI. The patients with TIMI grade 0~2 or TIMI grade 3 but residual stenosis ≥70% (132 patients in direct PCI group, 52 patients in facilitated PCI group) were implanted with stents. The rates of recanalization before and after PCI, of the usage of stents,of ST-segment resolution, and the left ventricular ejection fraction (LVEF) and major hemorrhage and major adverse cardiac events (MACE) in hospital were compared in two groups. Results: Compared with direct PCI group, the rates of recanalization and TIMI grade 3 before angioplasty were significantly higher in facilitated PCI group(49.2% vs 20.0%, P=0.00; 27.7% vs 14.0%, P=0.02); the rate of TIMI grade 3, ST resolution after angioplasty and LVEF in facilitated PCI group were significantly higher [96.9% vs 88.0%, P=0.04; 92.3% vs 78.7%, P=0.01; (64.5±7.9)% vs (51.5±15.6)%; P0.05]. There were not significantly different for usage of stents, major hemorrhage and MACE in two groups. There was no intracerebral bleeding in two groups. Conclusion: Facilitated PCI, which can reduce the time of reperfusion-beginning and improve the rate of TIMI grade 3 and myocardial reperfusion and left ventricular function without increasing MACE and major hemorrhage, is effective and safe for the patients with STEMI without thrombolysis contraindication.