The Effect On Myocardial Perfusion Of Nicorandil Combined With Ticagrelor On PPCI In The Patients With STEMI

Objectives:The aim of this study was to evaluate the effects of combination therapy with nicorandil and ticagrelor on myocardial perfusion in patients with ST-Segment Elevation Myocardial Infarction(STEMI)after primary percutaneous coronary intervention(PPCI).Methods:In a trail with 2-by-2 factorial design,we consecutive enrolled 205 patients with STEMI undergoing PPCI from January 2015 to December 2017 in 900 Hospital of the Joint Logistics Team.Patients randomly assigned into four groups:the clopidogrel treatment group(n=51),the ticagrelor treatment group(n=51),nicorandil combined with clopidogrel group(n=52)and nicorandil combined with ticagrelor group(n?51).All patients received aspirin 300mg and loading dose of P2Y12 receptor inhibitor(clopidogrel 600mg or ticagrelor 180 mg)before operation.In addition,the patients of nicorandil combined with clopidogrel group and nicorandil combined with ticagrelor group received intracoronary administration of 6 mg nicorandil through microcatheter after guide wire or balloon successfully crossed the infarct related vessels(IRA),followed by a continuous intravenous drip infusion of 3mg/h within 24 h after operation.The primary outcomes were myocardial perfusion.The secondary outcomes included the incidence of major adverse cardiovascular events(MACE)during hospitalization.Results:There were significantly difference in cTFC immediately after PPCI(33(23,45)frames,32(23,37)frames,29(20,36)frames and 22(17,35)frames)respectively,incidence of no reflow phenomenon(NRP)after PPCI(31.4%(1 6/5 1),19.2%(1 0/52)and 7.8%(4/5 1)respectively),ST-segment resolution within 4 hours after procedure(31.4%(16/5 1),33.3%(17/51),40.4%(21/52)and 70.6%(36/5 1))among 4 groups(P<0.01 or 0.05).In the multivariate logistic regression models,Nicorandil combined with ticagrelor could lower the cTFC level(OR=0.430,95%CI 0.252?0.734,P=0.002),acted as a protecting factor on lowering the incidence of NRP(OR=0.435,95%CI 0.256?0.740,P=0.002),as well as facilitating the ST-segment resolution at 4 hours after procedure(OR=1.742,95%CI 1.268?2.394,P=0.001)The occurence of fatal bleeding events and systolic blood pressure changes were both statically insignificant between groups(p>0.05).Conclusions:The results of this study demonstrated that combined theraphy with nicorandil and ticagrelor significantly improved myocardial perfusion,that is to say,lowered the cTFC level,reduced the occurrence of no reflow phenomenon,facilitated the ST-segment resolution after PPCI for STEMI and were generally safe.