Abstract
Objective To investigate the effect of target intracoronary injection of nicorandil for the prevention of no-reflow phenomenon (NRP) during emergency percutaneous coronary intervention(PCI) in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods The enrolled 105 cases of acute STEMI receiving emergency PCI in the Third Hospital of Hebei Medical University from January 2015 to September 2016 were randomized them into nicorandil group,sodium nitroprusside group and control group with 35 cases in each,and treated with target intracoronary injection of 2 mg nicorandil diluted in 10 ml 0.9% sodium chloride solution,200 μg sodium nitroprusside diluted in 10 ml 0.9% sodium chloride solution,and 10 ml 0.9% sodium chloride solution,respectively,into the place that was 2 mm distant from the target lesion via pre-dilated balloon and pressure pump.The TIMI flow grade of infarct-related artery,corrected TIMI frame count (cTFC),TIMI myocardial perfusion grade (TMPG) before and at the end of PCI,the incidence of NRP during PCI,the ST-segment resolution (STR) rate at 90 min after PCI were observed.N-terminal pro-brain natriuretic peptide (NT-proBNP) was measured before and at 1 week after PCI.CK-MB and cTnI were measured before and at every 4 h after PCI,and their peak levels were recorded.Color Doppler echocardiography was used to calculate the wall motion score index (WMSI) and left ventricular ejection fraction(LVEF) before and at 1 week after PCI.The incidence of hypotension during PCI and postoperative prognosis were observed.Results Before PCI,the TIMI flow grade,the proportion of patients with TMPG grade 3,NT-proBNP,values of CK-MB,cTnI,WMSI and LVEF did not differ significantly among the three groups(P>0.05).After PCI,compared with control group,the value of cTFC and the incidence of NRP in nicorandil group and sodium nitroprusside group were significantly decreased,but the proportion of patients with TMPG grade 3 and the proportion of STR ≥50% at 90 min after PCI were significantly increased (P<0.05);compared with the control group,the level of NT-proBNP,peak levels of CK-MB,cTnI and WMSI in nicorandil group and sodium nitroprusside group were significantly decreased,but the LVEF was significantly increased (P<0.05);there were no significant differences in the value of cTFC,the proportion of patients with TMPG grade 3,incidence of NRP,proportion of STR ≥50% at 90 min after PCI,level of NT-proBNP,peak levels of CK-MB,cTnI,WMSI and LVEF between the nicorandil group and sodium nitroprusside group(P>0.05).The incidence of hypotension in the control group,sodium nitroprusside group and nicorandil group was 9.1%(3/33),24.2%(8/33) and 0,respectively,which differed significantly among the groups (χ2=10.236,P=0.006);the sodium nitroprusside group had higher incidence of hypotension than the nicorandil group(P<0.01);patients with hypotension in both the control group and the sodium nitroprusside group were treated by dopamine.The incidence of MACEs 3 months after PCI was 15.2%(5/33),6.1%(2/33) and 5.9%(2/34) in the control group,sodium nitroprusside group and nicorandil group respectively,which showed no significant differences among the three groups(χ2=2.276,P=0.320).Conclusion For patients with acute STEMI receiving emergency PCI,target intracoronary injection of nicorandil is safe,which can effectively prevent the incidence of NRP during PCI,as well as improve the myocardial perfusion and cardiac function.关键词
心肌梗死/血管成形术,气囊,冠状动脉/无复流现象/尼可地尔Key words
Myocardial infarction/Angioplasty,balloon,coronary/No-reflow phenomenon/Nicorandil分类
医药卫生
