Roles Of Fasudil In Coronary Artery No-Reflow In STEMI Patients Undergoing PCI

Objective: No-reflow and slow flow defining as a coronary artery microvasculardysfunction is a common phenomenon in STEMI Primary PCI patients. This studysought to evaluate the effect of the new Rho-kinase inhibitor fasudil ic. viamicro-catheter in STEMI primary PCI patients with no-reflow and slow flowphenominon. The local coronary artery and femoral vein Rho-kinase activity were alsoevaluated to explore the mechanism of fasudil effects at coronary microvasular vessels.Methods： From6th，2010to9th2011,consecutive patients according withACC/AHA guidelines defined STEMI, showed coronary microvascular dysfunction inundergoing PCI. The patients were randomly divided to two group： fasudil (F group)or contral (verapamil, V group). F Group: when the patients showed coronarymicrovascular dysfunction in undergoing PCI，intra-infract related artery（IRA）administration of4mg/20ml/3min fasudil ic. via micro-catheter. V Group: when thepatients showed no-reflow and slow flow phenominon in undergoing PCI，intra-infractrelated artery（IRA）administration of0.5mg/20ml/3min verapamil ic. via micro-catheter.Factors as clinical general status，myocardial blush grad（eMBG）、ST-segment elevationresolution（STR,＞70%）at24-hour after DPCI, The local coronary artery and femoralvein Rho-kinase and eNOS、PGI2、ET-1were also evaluated.Result：1. There was no difference in baseline characteristics between two groups.Rho-kinase activity tested by western blot showed that the WBC’S Rho-kinase activityin coronary lesion site was higher than that in femoral vein and was inhibited by fasudil4mg ic. Within15min.2. MBG grade F group vs. V group was2.10±0.11vs.1.50±0.13, P=0.003; ratio of24h-STR>70%was68%vs.45%, P=0.004. 3. Before the treatment the1evels of intra-infract related artery serum eNOS、PGI2、ET-1had no significant difference between two groups. After treatments theeNOS and PGI2were obviously increased, the ET-1was decreased significantly in bothgroups. the changes were more obvious in the F group．Conclusion: Rho-kinase activity in coronary lesion site was higher than that infemoral vein in STEMI primary PCI patients with no-reflow and slow flowphenomenon. Rho-kinase activity was effectively inhibited by fasudil via modulatingendothelial dysfunction mechanism. Moreover, the efficacy of fasudil to reliveno-reflow and slow flow is superior than that of verapamil.