| Objectives: To investigate prophylactic use of target intracoronary administration of nicorandil for the prevention of no-reflow phenomenon(NRP)in acute ST-segment elevation myocardial infarction(STEMI)patients who was underwent emergency percutaneous coronary intervention(PCI),and compared with sodium nitroprusside.Methods: From January 2013 to December 2016,a total of 120 patients with acute STEMI in the Third Hospotal of Hebei Medical University who received emergency PCI were enrolled in this study.The enrolled 120 cases were randomly divided into three groups: nicorandil group,sodium nitroprusside group and control group.Each group had 40 cases.Patients in the nicorandil group(N = 40)were injected 2 mg nicorandil to the target vessel 2 mm beyond the point of occlusion with pre-dilation balloon.Patients in the sodium nitroprusside group(N = 40)were injected 200 ?g sodium nitroprusside.Patients in the control group(N = 40)received neither of these two drugs.The thrombolysis in myocardial infarction(TIMI)flow grade,corrected TIMI frame count(cTFC)and TIMI myocardial perfusion grade(TMPG)of the infarct-related artery(IRA)were observed before and after emergency PCI.The incidence of NRP during emergency PCI was observed.A 12-lead electrocardiogram was recorded before and at 90 minutes after emergency PCI,and ST-segment resolution(STR)was measured.The level of n-terminal pro-brain natriuretic peptide(NT-proBNP)was measured before and at 1week after emergency PCI.The levels of creatine kinase isoenzyme-MB(CK-MB)and cardiac troponin I(cTnI)were measured before and at every 4hours after emergency PCI,and their peak levels were recorded.The color Doppler echocardiography was used to calculate the wall motion score index(WMSI)and left ventricular ejection fraction(LVEF)before and at 1 week after emergency PCI.The LVEF was also calculated 1 month after emergency PCI.The blood pressure and heart rate before and after emergency PCI were recorded.The incidence of intraoperative hypotension was observed and calculated.The major adverse cardiovascular events(MACEs)were recorded during hospitalization and 3 months after emergency PCI.Results:1 Clinical characteristics: There were 120 patients included in this study and they were divided into three groups: nicorandil group,sodium nitroprusside group and control group,40 cases in each group.There was no significant difference in the gender,age,body mass index,previous myocardial infarction,coronary risk factors(hypertension,hyperlipoidemia,diabetes mellitus and smoking),blood chemistry(glucose,hemoglobin A1 c,total cholesterol,triglyceride,low-density lipoprotein cholesterol and serum creatinine),the Killip class,uses of the medicine(aspirin,clopidogrel/ticagrelor,angiotensin-converting enzyme inhibitors/angiotensin receptor blockers,calcium channel blockers,?-blockers,atorvastatin and tirofiban)and the distribution of the IRA among the three groups.There was no significant difference in the time from the onset of acute STEMI to emergency PCI among the three groups(P > 0.05).2 Coronary angiography and emergency PCI: Before emergency PCI,there was no difference in the TIMI flow grade,the value of cTFC and the proportion of TMPG grade among the three groups(P > 0.05).After emergency PCI,the rate of NRP was signifcantly lower in the sodium nitroprusside group and nicorandil group compared to the control group(P =0.013).The proportion of TIMI grade 3,TMPG grade 3 and the complete STR(CR)cases were signifcantly higher in the sodium nitroprusside group and nicorandil group than those in the control group(all P < 0.05),while the value of cTFC was significantly lower(P < 0.05).However,there was nodifference in the rate of NRP,the TIMI flow grade,the value of cTFC,the proportion of TMPG grade and STR between the sodium nitroprusside group and nicorandil group after emergency PCI(P > 0.05).3 Blood chemistry and color Doppler echocardiography: Before emergency PCI,the values of NT-proBNP,CK-MB,cTnI,WMSI and LVEF did not differ significantly among the three groups(P > 0.05).After emergency PCI,the value of NT-proBNP,the peak levels of CK-MB,cTn I and WMSI in the sodium nitroprusside group and nicorandil group were significantly lower than those in the control group(all P < 0.05).While the LVEF 1 week and 1 month after emergency PCI in the sodium nitroprusside group and nicorandil group were signifcantly higher than that in the control group(P < 0.05).However,all the above data(NT-proBNP?CK-MB?cTnI?WMSI and LVEF)showed no signifcant difference between the sodium nitroprusside group and nicorandil group after emergency PCI(P > 0.05).4 Intraoperative hypotension and clinical follow-up: There was no difference in the vital sigh(blood pressure and heart rate)among the three groups before and after emergency PCI(P > 0.05).The rate of intraoperative hypotension in the control group,sodium nitroprusside group and nicorandil group were 12.5%(5/40),25.0%(10/40)and 5.0%(2/40),respectively,which differed significantly among the three groups(P = 0.035).And the rate of intraoperative hypotension in the sodium nitroprusside group is higher than that in the nicorandil group(P = 0.028).The incidences of MACEs in hospital and three-month after emergency PCI showed no significantly difference among the three groups(P > 0.05).Conclusions: Prophylactic use of nicorandil in target coronary artery in patients with acute STEMI underoing emergency PCI can effectively and safely reduce the incidence of NRP and improve myocardial perfusion and cardiac function.Compared with sodium nitroprusside,nicorandil has little effect on blood pressure. |
PDF Full Text Request