Myocardial Protective Effect Of Oxycodone Prolonged-release Tablets On Patients With Acute ST-segment Elevation Myocardial Infarction Undergoing Primary PCI

Objective To investigate the effects of oxycodone prolonged-release tablets on myocardial protection and myocardial perfusion in patients with acute ST-segment elevation myocardial infarction(STEMI)undergoing primary percutaneous coronary intervention(PCI),and to evaluate its safety.Methods Totally,one hundred and two patients with acute ST-segment elevation myocardial infarction were included into this study.The patients were randomly divided into oxycodone group and control group,with 51 cases in each group.Besides the routine loading doses of dual antiplatelet drugs and heparin 3000 u intrvenous bolus injection,patients in the oxycodone group were given oxycodone prolonged-release tablets 10 mg orally within 30 minutes before operation,and the control group was given placebo.The remaining managements were the same.Baseline data of the two groups were collected.The perioperative hemodynamics and the TIMI blood flow after PCI were recorded.The evaluation of cardiac function before and after surgery and the incidence of no reflow was calculated.The risk factors of no reflow was analysed by logisitic regression.Results There were no significant difference in the baseline data of gender,age,hypertension,diabetes and smoking history between the two groups(P>0.05).There was no significant difference in hemodynamics between the two groups(P>0.05).There was no significant difference in systolic blood pressure,diastolic blood pressure,mean arterial pressure and heart rate between the two groups at six time points(T0: at admission;T1: 30 minutes before surgery;T2: surgery started;T3: surgery ended;T4: returned to the ward;T5:6 hours after surgery.)(P>0.05).There was significant difference in TIMI blood flow grade between the two groups(P<0.05).The overall incidence of no-reflow was 18.6%,while it was7.8% in the oxycodone group,and 29.4% in control group(P<0.05).The incidence of no-reflow was lower in the oxycodone group than in the control group,and the difference was statistically significant(P<0.05).Logistic regression analyses found that oxycodone(OR=0.20,95%CI: 0.06-0.67,P<0.05)was a protective factor for no-reflow,however,low-density lipoprotein cholesterol(OR=2.66,95% CI: 1.20-5.89)were risk factors of no-reflow(P<0.05).There was a statistically significant difference in CK-MB between the two groups at 12 hours after PCI.The degree of recovery in NT-proBNP and LVEDD and LVEF of echocardiography in the oxycodone group was significantly higher than that in the control group at 30 days after PCI(P<0.05).There was no significant difference in the incidence of ventricular fibrillation,secondary admission,angina pectoris and mortality between the two groups(P>0.05).There were significant differences between the two groups in stent thrombosis,heart failure and secondary surgery(P<0.05).The incidence of overall adverse cardiovascular events in the two groups was lower in the oxycodone group than in the control group,and the difference was statistically significant(P<0.05).Conclusion: 1.Oxycodone is safe in STEMI patients undergoing primary PCI because it hasn't adverse effect on perioperative hemodynamics.2.Oxycodone improves myocardial perfusion after primary PCI and reduces the incidence of no-reflow.3.Oxycodone may improve cardiac function and reduce the incidence of adverse cardiovascular events in patients with STEMI 30 days after primary PCI.