| Objective: To observe the curative effect for oral nicorandil drug inpatients with severe coronary artery disease, whose coronary angiographyshowed triple lesions, and without revascularization.Methods: Collect all the data of patients who consistent with selectedcondition, including gender, age, admission blood pressure, blood creatinine,blood lipid, and left ventricular ejection fraction (LVEF), wall motion scoreindex (WMSI), nitrate consumption, BNP, Holter, family history, diabeteshistory, PCI history, history of CABG and history of myocardial infarction inpatients, basic drugs.Patients with coronary angiography within half year or after admissionshowed severe three branch disease were selected, with orwithout complicated with left main disease, because the distal circulation ispoor, unable to CABG operation, or the coronary artery lesions in patients canbe revascularization, but the patients and their family members refused to PCIand CABG treatment, Conservative treatment by drugs were given afterconsultation with the patient and family members.The patients were randomly divided into the conventional treatmentgroup as control group (n=36,male/female=20/16) and nicorandil group(n=40,male/female=23/17).Conventional treatment group was given aspririn,β-blockers, ACEI, statins, diltiazem hydrochloride, clopidogrel,trimetazidine,hydrochloride, isosorbide mononitrate; nicorandil group was given aspirin,β-blockers, ACEI, statins, diltiazem hydrochloride, clopidogrel, trimetazidinehydrochloride, mononitrate，nicorandil (5mg tid). According to the conditionof patients with heart failure can give strong heart drug digoxin and diureticfurosemide moderate,and with hypoglycemic agents or insulin in diabeticpatients. Testing the basic situation of patients with heart rate, blood pressure, body temperature, respiratory rate and so on during the period ofhospitalization. To observe malignant ventricular arrhythmia includingventricular fibrillation and ventricular tachycardia, ST segment change byECG monitoring.Observation index: Comparison of the basic data of patients at admission.Changes of the frequency of angina pectoris attack, nitrateconsumption, malignant arrhythmia, ST segment trend monitoring by Holter,left ventricular ejection fraction, ventricular wall motion score, the level ofBNP and MACE after treatment for1months and6months.Statistical methods: The data were analyzed by SPSS20.0, there issignificant difference when P <0.05.Result:1. Comparison of basic dataComparison of the basic data of patients at admission between two group,Measurement data including age, diastolic blood pressure, systolic bloodpressure, serum creatinine, LDL-C, left ventricular ejection fraction wereanalyzed by t test, the results are all P>0.05, No significant differences. Thecount data including those with gender, hypertension, diabetes, history ofPCI, CABG history, history of myocardial infarction, and basic drugsincluding aspirin,β blockers, ACEI, statins, diltiazem hydrochloride were chisquare test, all P>0.05,no statistical significance.2.The frequency of angina pectoris attack and durationThere are no different of the frequency of angina pectoris attack andduration between the conventional therapy group and nicorandil group beforetreatment. The numbers of angina pectoris effectively alleviate after1monthsof treatment were7(19.44%) vs18(45%), P=0.018; The numbers were10(27.78%) and22(55%) after6months treatment, P=0.016.Nicorandil group isbetter than the conventional therapy group.3. Comparison of HolterNumbers of the patients who had Curtis-Walker score≥3which isMalignant arrhythmia evaluation standard, were14(38.89%) in the conventional therapy group vs7(17.50%) in the nicorandil group,P=0.037.6months after treatment, the numbers were13(36.11%) vs5(12.50%), P valueis0.016. Nicorandil group is better than the conventional therapy group.The ST segment trend picture: Comparing of episode number withpatients in the two groups, after1months treatment, they were1.11±0.62vs0.90±0.55, P=0.119; and6months after treatment1.03±0.56vs0.68±0.57,P=0.008. ST segment depression between the two groups was1.02±0.32vs0.84±0.27after1months treatment, P=0.01;6months after treatmentbetween the two groups was0.91±0.31vs0.67±0.24, P=0.000. Theduration between the two groups after1months of treatment was8.19±2.48vs5.12±2.04, P=0.000,6months after treatment between the twogroups was7.07±2.35vs3.66±1.59, P=0.000. Nicorandil group is betterthan the routine treatment group.4.Nitroglycerin consumptionNitroglycerin consumption in the two groups were19.31±3.74vs16.36±3.29after1months of therapy, P=0.000; After6months of treatment, thenumbers were17.44±3.45vs10.46±2.64, P=0.000.Nicorandil group isbetter than the routine treatment group.5. Ultrasonic cardiogramComparison of patients with left ventricular ejection fraction(LVEF),after1months of therapy, the results of conventional treatment group andnicorandil group were:46.72±6.03vs48.15±5.59; P=0.302, no difference.After6months of therapy, they were48±6.04vs53.83±5.69; P=0.000,there was significant difference, nicorandil group is better than the routinetreatment group.Comparison of Wall motion score index(WMSI) between the two groups,they were2.32±0.63vs2.07±0.57after1months of treatment, P=0.071;6months after treatment the numbers of the two groups were2.06±0.57,1.58±0.49, P=0.000. Nicorandil group is better than the routine treatment group.6.Brain natriuretic peptide(BNP) Compared with the data of the two groups after treatment, the levels ofBNP in patients between the two groups were405.37±133.13vs364.89±121.03after1months treatment, P=0.169; after6months of treatment, BNPlevels in the two groups were367.45±116.45vs314.01±95.16, P=0.031.Nicorandil group is better than the routine treatment group.7.Comparison of the incidence of adverse cardiovascular events7.1Acute myocardial infarction(AMI):there were36persons in theconventional treatment group, the cases of acute myocardial infarction after6months treatment were2people(5.56%); The case is1(2.5%) with acutemyocardial infarction in the nicorandil group. Comparison with twogroups, the P=0.601, no statistical significance.7.2Sudden cardiac death(SCD): Patients in the2groups during6months of treatment, no sudden cardiac death cases.Conclusion: Curative effect for nicorandil is obviously superior tothe conventional drug treatment in patients of Severe coronary artery diseasewith Drug conservative treatment， can improve angina and heart failure... |
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