The Effects Of Anisodamine Combined With Ischemic Postconditioning On Myocardial Perfusion In Patients With ST-segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Objectives: The aim of this study was to evaluate the effects ofanisodamine combined with ischemic postconditioning on myocardialperfusion in patients with ST-segment elevation myocardial infarction (STEMI)undergoing primary percutaneous coronary intervention (PCI).Methods: From August2011to December2012, a total of eighty patientswith first-time STEMI who underwent primary PCI within12hour ofsymptom onset were enrolled in this study. The patients were randomlyassigned to1of the4groups: control group (CON), anisodamine group (ANI),ischemic postconditioning group (IPTC), combination treatments group (ANI+IPTC).Each group have20patients. After a full preoperative preparation, allpatients underwent emergency coronary angiography (CAG) to clear theinfarct related artery (IRA). The lesion of IRA was treated by percutaneoustransluminal coronary angioplasty. CAG and PCI were performed viatransradial artery approach for all patients. Patients in ANI group and ANI+IPTC group received intracoronary bolus injection of2000ug anisodamine(concentration100ug/ml) after the IRA to restore blood flow. In CON groupand IPTC group, equal volume of saline was injected into the coronary arteryin the same way. IPTC group and the ANI+IPTC group within1min ofreperfusion, operated by3episodes of30seconds inflation and30secondsdeflation with the angioplasty balloon before continuing reperfusion. CONgroup and ANI group were without intervention in the later3minutes afterreperfusion, then underwent routine stenting. All patients were implanteddrug-eluting stents.Detailed recorded the basic clinical data of patients in eachgroup, including mean age, gender distribution, risk factors (hypertension, diabetes, dyslipidemia, smoking history), myocardial infarction site, cardiacfunction, and clinical presentations. We recorded and compared the correctedTIMI frame count (CTFC) and TIMI myocardial blush grades (TMBG).Invasive hemodynamic parameters were monitored by PC Scout Monitor90309(Spacelabs Medical Inc USA) in the course of operation. Myocardialenzymes were observed after pPCI, and the peak of CK-MB were compared.WMSI (wall motion score index), LVEF (left ventricular ejection fraction),LVEDV (left ventricular end diastolic volume), LVESV (left ventricular endsystolic volume), CI (cardiac index)were observed and recorded byechocardiography at1week after pPCI in order to assess the wall motion andthe recovery of ventricular function. Besides, the major adverse cardiac events(MACE) in hospital of the four groups patients, including cardiac deaths,recurrent nonfatal myocardial infarction, severe heart failure, malignantarrhythmias and target vessel revascularization were observed. Analyses weredone using SPSS19.0. A two-sides of P<0.05was defined as statisticallysignificant.Results: A total of80patients were enrolled,20cases in each group. Nosignificant difference in baseline clinical characteristics was found amonggroups, including mean age, gender distribution, risk factors (hypertension,diabetes, dyslipidemia, smoking history), myocardial infarction site, cardiacfunction, and clinical presentations (all P>0.05). There were no significantdifferences about infracted related artery and multi-vessel lesion amonggroups (all P>0.05). In addition, there were no differences in the number ofstents, diameters, length that used in primary PCI (all P>0.05). The CTFC ofeach coronary artery in ANI, IPTC and the ANI+IPTC group was lower thanthose in control group, and the proportion of patients with TMPG3grade wasmuch higher (all P<0.05).Peak of CK-MB level in ANI, IPTC and the ANI+IPTC group was significantly lower than the CON group (all P<0.05).Compared to CON group, the left ventricular ejection fraction (LVEF) and CIwere higher, LVEDV, LVESV and WMSI were lower in ANI, IPTC and theANI+IPTC group (all P<0.05). No significant difference of occurrence of MACE was found among groups (all P>0.05). Compared to CON group, theincidence of malignant arrhythmia is lower in ANI and ANI+IPTC group, butthe difference was not found to have statistically significant (both P>0.05).Each group has one patient with severe heart failure. None of the patients ineach group occurred recurrent myocardial infarction, repeat revascularizationand cardiogenic death. Within intracoronary administration of anisodamine5minutes, the heart rate increased significantly (about10to15times/min), andreturned to baseline levels about10minutes. Logistic regression analysisshowed that anisodamine and ischemic postconditioning have synergy trendsto reduce infarct size and improve cardiac function.Conclusion:1. Both anisodamine and ischemic postconditioning can improve thecardiac function and myocardial perfusion, reduce infarct size and inhibit leftventricular remodeling in STEMI patients undergoing primary PCI. Thecombination of anisodamine and ischemic postconditioning maybe has bettereffect.2. Intracoronary administration of anisodamine combined with ischemicpostconditioning is safe in STEMI patients undergoing primary PCI.