The Effects Of Nicorandil On Microcirculation Of Coronary Artery And Short-term Prognosis In Patients With STEMI After Primary Percutaneous Coronary Intervention

Objectives:For patients with acute ST-segment elevation myocardial infarction?STEMI?,early,effective and continuous recovery of blood flow of infarct-related arteries can reduce myocardial infarct area,protect left ventricular function,and reduce major adverse cardiac events?MACE?and mortality.Primary percutaneous coronary intervention?PPCI?is the most important means of revascularization in STEMI patients,but“no reflow?NR?”phenomenon was still observed in 10%-20%of STEMI patients after PPCI,leading to deterioration of cardiac function,malignant arrhythmia,death and other adverse cardiac events.Studies have shown that coronary microcirculatory dysfunction after PCI including distal microembolism and microvascular spasm,and myocardial ischemia/reperfusion injury were important mechanisms of no reflow.The nicorandil,as an ATP-sensitive K-channel(K_ATP)opener,is thought to be able to dilate coronary microvessels,improve myocardial perfusion,and reduce myocardial ischemia/reperfusion injury,thus improving clinical prognosis in patients with STEMI.This study aims to observe the effect of intracoronary combined intravenous infusion of nicorandil on microcirculation of coronary artery and short-term prognosis in patients with STEMI after PPCI.Methods:A prospective,randomized,controlled study was performed and consecutively enrolled 106 patients with STEMI who received PPCI from January 2017 to January2018 in our heart center.According to whether nicorandil was administered intracoronary in PCI and intravenously after PCI,they were randomly divided into two groups,53 cases in each group.Nicorandil group:Intracoronary injection of nicorandil 4mg was performed during PPCI?as the recovery of blood flow partly,so-called TIMI blood flow?1 in infarct-related arteries,before balloon dilation and stent implantation?,then nicorandil was intravenously infused at 4mg/h for 24hours;Control group:Only routine PPCI was performed without nicorandil.The two groups of patients were treated with conventional STEMI medication during and after PPCI in accordance with the relevant guidelines.The basic condition,the condition of admission,and the data of PPCI of two groups patients were collected and recorded.Main observation indexes were as follows:TIMI flow in IRA,TIMI myocardial perfusion frame count?TMPFC?,electrocardiographic ST-segment recovery?STR?at90 minutes after PPCI,CK and CK-MB peak,incidence of acute heart failure?AHF?during hospitalization and left ventricular ejection fraction?LVEF?at 1 week after PPCI.Secondary observation indexes:major adverse cardiac events?MACE?during hospitalization,including recurrent myocardial infarction,target vessel revascularization?TVR?,and death.In addition,the adverse reactions in the two groups were observed.Results:The baseline clinical data showed that the patients combined with diabetes was more in nicorandil group than in control group?P<0.05?.The time from admission?door?to balloon dilation?D-to-B?was longer in nicorandil group?P<0.05?.For the data of PCI,the proportion of thrombus aspiration and stent implantation during PCI were higher in nicorandil group?P<0.05,P<0.05?.The remaining baseline clinical data were not significantly different between the two groups,including age,gender,hypertension,hyperlipidemia,smoking history,the time from onset to admission,Killip classification before PPCI,number of ST-elevation leads in ECG,systolic blood pressure at admission,serum creatinine?Cr?,blood glucose and low density lipoprotein cholesterol?LDL-c?at admission,the proportion of TIMI blood flow=3 in the IRA before intervention,the proportion of the IRA being LAD,and the proportion of using glycoprotein IIbIIIa receptor antagonist?tirofiban?.Main outcome indicates:the rate of TIMI blood flow=3 in IRA after PCI in nicorandil group was not significantly different from that of control group,however,the TIMI myocardial perfusion frame count?TMPFC?was significantly less in nicorandil group than in control group?P<0.05?.The percentage of ST segment recovery in ECG at 90minutes after PCI was higher in nicorandil group?P<0.05?;The peak of CK and CKMB and the incidence of acute heart failure?AHF?during hospitalization were not significantly different between two groups.In addition,the LVEF at 1 week after PCI was higher in nicorandil group than in control group?P<0.05?;There were no statistically significant difference in MACE?including recurrent myocardial infarction,TVR,and death?in two groups.The adverse reaction,such as headache,hypotension,ALT and TBIL during 24 hours after PPCI,had no significant difference in two groups,either.Conclusion:The intracoronary use of nicorandil during PPCI in patients with STEMI can significantly improve coronary microcirculatory status and myocardial perfusion,achieving the real purpose of emergency revascularization treatment.The use of nicorandil intravenously after PPCI can maintain myocardial perfusion continuously,which can reduce the infarct area,protect the myocardium,improve the short-term prognosis of patients with STEMI.The use of nicorandil failed to reflect the reduction of MACE during hospitalization.This result may be related to the small sample size and the shorter observation time.The intracoronary and intravenous use of nicorandil had a good safety and may be worthy of clinical promotion.