The Effects Of Intracoronary Diltiazem On Coronary Microvascular During Percutaneous Coronary Intervention After Fibrinolysis For Acute ST Elevation Myocardial Infarction

Objective: To study the effect s of intr acoronary diltiazem on coronary microvascular during percutaneous coronary intervention(PCI)after fibrinolysis for patients with acute STEMI.Methods: 44 patients were s elected as objects of the study who were diagnosed as acute ST-segment elevation myocardial infarction and were going to receive percutaneous coronary intervention after fibrinolysis from February 2014 t o November 2015 in the cardiovascular department of the Third Hospital of Hebei Me dical University,6 of which wer e exclusive from this experiment because of unsuccessf ul fibrinolysis.Those patients with serious heart failure,hypotent ion,sustained ventricular tachycardia,severe hepatic or renal dysfunc tion,or anemia were excluded.All objects were randomly divided into two groups after signing informed consent forms:in the study group who received intracorona ry diltiazem through guiding catheter(n=20),while in the control group who received intracoronary isotonic saline at t he same t ime(n= 18).To record the baseline clinical data such as age,gender,heart rate,mean blood pre ssure,smoking history,complications(hypertension,diabetes,and dyslipi demia),the time from onset to fibrinolysis,time from fibrinolysis to balloon.And the coronary angiography data:infarct related artery,the number of lesion artery and the stents,the thrombolysis in myocardial infarction(TIMI)flow grade,and TIMI myocardial perfusion grade(TMPG)before and after the stent implanted.we also o bserve heart rate and blood pressure after op erations,the left ventricle ejection fraction(LVEF)1 week after PCI,the ma jor adverse cardiac enents(MACEs)3 months after PCI.Results: There were no statistically dif ferences between the two groups in baseline characteristics,so me angiographic characteristics(such as infarct related artery,the number of lesion arte ry and the stents,initial TIMI,initial TMPG),heart rate and bloo d pressure after operations,L VEF1 week after PCI,the MACE 3 months after PCI.Wh ile the study group was signific antly better in the TIMI flow grade and TMPG after the stent i mplanted compared with the control group,and t he differences were considered statistically significant.Conclusions:For patients undergoing PCI after fibri nolysis with acute STEMI,the intracoronary diltiazem through guidi ng catheter can im prove TIMI and TMPG,thus increase coronary microva scular;Meanwhile,it does not have adverse effects on heart rate and blood pressure after PCI.