Study on the clinical efficacy of immediate PTCA and primary intracoronary stent after intravenous rt-PA thrombolytic therapy in acute myocardial infarction

Objective:To study the clinical efficacy of immediate percutaneous transluminal coronary angioplasty (PTCA) and primary intracoronary stenting after intravenous thrombolytic therapy using recombinant tissue plasminogen activator (rt PA) in patients with acute myocardial infarction (AMI).Method:From January 1998 to July 2001, one hundred and forty consecutive patients with AMI were divided into two groups. In group A, 75 patients received intravenous thrombolytic therapy using rt PA 50 mg before they had coronary aniography (CAG), PTCA and primary intracoronary stenting. In group B, 65 cases only received CAG, PTCA and primary intracoronary stenting. Left ventricular ejection was measured by two dimensional echocardiography and cardiac events were recorded during follow up.Result:①The first CAG when patients received cardiac catheterization showed that the re open rate of infarct related artery (IRA) in group A was 52% , while that in group B was 15%. The difference between group A and group B was significant (P 0.01 ).②The re open rate of IRA in operated PTCA and stenting in group A and B was similar ( group A 100%; group B 98.6 % ). ③ At 20 days follow up, the left ventricular ejection fraction reached or exceeded 60% in group A was 95%, while that in group B was 44%. The difference between group A and group B was significant (P 0.05 ). ④No complications of cerebral hemorrhage and hemorrhage were found in group A and group B .⑤ The mortality in hospital in group A was 4%, While that in group B was 3% , The difference between group A and group B was insignificant (P 0.05 ).Conclusion:Comparison of the clinical curative effect between previous intravenous rt PA plus percutaneous coronary intervention (PCI) and PCI alone in AMI shows that the former method can reopen IRA earlier, decrease the complication in the operation of intracoronary stenting, protects the left ventricular ejection fraction more effectively and does not increase heart events happening.