Effects Of Sodium Nitroprusside On PCI-related Perioperative Myocardial Infarction

BackgroundWith the rapid development of percutaneous coronary intervention(PCI)and the continuous emergence of complicated coronary intervention techniques,PCI has become an important method in the treatment of coronary heart disease.PCI related perioperative complications(such as: perioperative myocardial infarction,thrombosis,stroke,bleeding)are also increasingly concerned by clinicians.Among them,perioperative myocardial infarction(PMI)is most common.Many clinical studies have confirmed that in patients undergoing elective PCI,the incidence of postoperative myocardial markers up to 28.7%,PMI was about 14.5%.The incidence of postoperative myocardial markers are increased up to 28.7%,PMI incidence is about 14.5%.Although most patients do not have significant clinical symptoms,but elevated myocardial markers suggest that perioperative acute myocardial damage,even slightly elevated,may also lead to a higher risk of death.Studies have shown that PMI is closely related to the increase in endogenous mortality and long-term adverse events(death,myocardial infarction,and severe myocardial ischemia)after PCI.Theoretically,reducing the PMI can reduce the risk of death and improve the prognosis in patients with PCI,but the current treatment to reduce the incidence of PMI is less.ObjectiveThe purpose of this study was to assess the safety and efficacy of intracoronary sodium nitroprusside in the prevention of PMI during elective PCI.MethodsFrom October 2016 to August 2017,a total of 180 patients with elective PCI were randomly divided into two groups.The patients in the treatment group received coronary artery injection of sodium nitroprusside 100 ug before stent implantation and non-compliant balloon dilatation,while the control group did not receive sodium nitroprusside.The cTnT will be test before PCI and within 24 h after PCI in both two groups inorder to compare the number of patients with PMI and to observe whether intracoronary injection of sodium nitroprusside can reduce the incidence of PMI;perioperative complications,Major adverse cardiac events during hospitalization.Follow-up of six months to observe whether target lesion revascularization,recurrent angina,and major adverse cardiovascular events occur.SPSS21.0 statistical software was used for statistical analysis of the two groups of data.Results1.There was no statistical difference in gender,age,hypertension,diabetes,family history,smoking history,HbAlc,blood lipid levels(TC,TG,HDL,LDL),CREA,eGFR,Pro-BNP,LVEF.2.Both groups took aspirin and statins during hospitalization.Sixty patients in the treatment group received Clopidogrel bisulfate tablets,which was similar to the control group(66.7% vs.54.4%,p=0.093).The remaining patients all received Ticagrelor.There was no statistical difference between the two groups.In the treatment group,GPIIb/IIIa receptor antagonists were used in 70% of patients after PCI and 76.7% in the control group.There was no significant difference between the two groups.3.There were 6 cases of PCI-related PMI in the treatment group and 17 cases in the control group.The incidence of PCI-related PMI in the treatment group was significantly lower than that in the control group(6.7% vs.18.9%,p=0.014).the difference was statistically significant.In the control group,there were 4 cases of slow blood flow/no reflow,while in the treatment group 1 case of slow blood flow/no reflow occurred.The incidence of slow blood flow/no reflow was lower in the treatment group than in the control group(1.1 vs.4.4 %,p=0.174),but the difference between the two groups was not statistically significant.4.The number of target vessels treated in both groups was comparable,with no statistically significant difference(P>0.05).There was no statistically significant difference in preoperative blood pressure between the two groups(P<0.05),but the immediate postoperative blood pressure in the treatment group was significantly lower than that in the control group,and the difference was statistically significant(p<0.05).No adverse cardiac events occurred during hospitalization in both groups.5.In the treatment group and control group,there was one target lesion revascularization during the six-month follow-up period,and one case of MACE occurred during the follow-up period in the treatment group.The incidence of recurrence of angina was similar between the two groups(2.2% vs.5.6%,p=0.247),and there was no statistically significant difference between the two groups.ConclusionIntracoronary injection of sodium nitroprusside during elective PCI can reduce the incidence of perioperative myocardial infarction.