Fasudil Intracoronary Infusion Via Micro Catheter To Treat Reflow Or Slow-flow Phenomenon In Stemi Primary PCI Patients

Objective：No reflow or slow reflow is a common phenomenon occurred inSTEMI Primary PCI patients. This study tried to explore the intracoronary Rho-rockinhibitor Fasudil effects via micro catheter on no-reflow or slow flow phenomenonhappened directly after stent opening the criminal vessels. The Fasudil effects were alsocompared with Verapamil in TIMI frame count (CTFC) and myocardil blushgrade(MBG) in those patients.Methods:86patients were enrolled in this study with diagnosed acuteST-segment elevation myocardial infarction (STEMI). All of the patients werefrom First Affiliated Hospital of Dalian Medical University consecutively from May2010to Nov2011. Enrolment criteria were： age﹤80STEMI patients, Primary PCIwithin6-12hours, door-to-balloon time (DTB)﹤90minutes, myocardial infarctionthrombolysis experiment (TIMI) flow grade﹤2, or TIMI3class and MBG grading0-1.Exclusion criteria were cardiogenic shock; collateral circulation at the infarct relatedartery; dissection caused no reflow or slow flow; distal thrombosis embolization;untolerating the dual antiplatelet drugs; white blood-cells﹤3.5×109and or platelet coun﹤100.000mm3or﹥750,000mm3; renal insufficiency, serum creatinineconcentration(Scr)﹥2.0mg/dl.The86patients were randomly divided into the fasudil group (F group, n＝45)and verapamil group (V group, n＝41). The Rho-Rock inhibitor Fasudil4mg orVerapmil0.5mg were infused ic. With progreat2.4F micro-catheter placed at the distalwhen no reflow an slow flow occurred after opening, obstruced infarct related vesselswith stents. The following observations were:1. Microvascular level blood flow: TIMIGrade, corrected TIMI frame count(CTFC), classification of myocardial blush grade(MBG).2.The ischemic indicators CKMB、 CTnI and BNP were tested.3.Comparing tow groups with hs-CRP and24-hours ECG ST segment resolution(STR),The hemodynamic factors like blood pressure and heart rate were also observed.4. Toobserve the incidence of (MACE) and LV function recovery in30days.Results: The basic clinical data such as risk factors, distribution of coronaryartery lesions, coronary thrombus burdens were compared with no significant difference.The Rho-Rock activities in STEMI patients were obviously higher that the normalperson. The blood flows were restored faster in F group than in V group (TIMI2.81±0.19vs2.24±0.23, P＝0.006; CTFC27.4±17.2vs30.5±21.7, P=0.029), bettermirova-sular blood recovery MBG2.96±0.28vs2.18±0.53, P=0.039); lesscardiacischemic damage (CKMB peak value96±3.26vs113±4.35U/L, P=0.032;CKMB time to peak:6.87±0.26vs7.33±0.76h, P=0.039; CTnI peak value:2.96±0.47vs3.97±0.62ug/L, P=0.023; CTnI time to peak:8±0.28比9±0.47h, P=0.014。LV functionwere improved (BNP:67.74±3.29vs86.74±3.28, P＝0.019; LVED/d:50.4±4.6vs56.2±4.8mm, P＝0.013; LVEF:51.3±3.1%vs45.1±3.4%, P＝0.015; hs-CRP14.17±3.26vs17.91±2.64mg/l, P＝0.017); The ECG results showed24hour STR﹥78%in F and V group(0.38±0.13vs0.46±0.07, P＝0.034. The MACE incidence at30days after Primary PCI in F and V group were11.1%vs24.3%, P＝0.026.Conclusions: The Pho-Rock inhibitor Fasudil can restore coronary blood flowrepidly in STEMI primary PCI patients with no-flow or slow flow phenomenon. TheCTFC and MBG resluts were improved after Fasudil ic Via microcatheter. TheRho-Rock activities in STEMI patients were obviously higher than that of the normalperson indicated than Fasudil may be effect on the coronary microvascular level.Compared with the intracoronary injection of verapamil, the common vasodilator drugsused in no-reflow or slow flow, the Fasudil has a better results on CTFC and MBG.Those results made a better LV functionk, highter ECG STR percentage, less cardiacischemic damage and improved MACE incidence at30days.