Effect Of Oral High-dose Nicorandil On No-reflow /Slow-flow In Patients With Acute Coronary Syndrome During PCI And Its Evaluation Of Cardioprotective Effect

BackgroundCoronary atherosclerotic heart disease(CAD)is still a major threat to human health in the worldwide.Acute coronary syndrome(ACS)is one of the most urgent and critical types of CAD,which includes unstable angina pectoris,ST-segment elevation myocardial infarction(STEMI)and non-ST-segment elevation myocardial infarction(NSTEMI).The morbidity and mortality of ACS is increasing year by year.Therefore,how to choose the best treatment to improve the prognosis for ACS patients is always a challenge to our cardiologist.Percutaneous coronary intervention(PCI)is the main method of treatment.However,in clinical practice,it often occurs that thrombolysis in myocardial infarction flow 3 can not be restored after the opening of the culprit vessel,which can not alleviate or even aggravate myocardial ischemia.Previous studies have shown that 5% ~ 50% of patients may have no-reflow and slow flow(NR/SF)during PCI.Nicorandil,a hybrid compound of ATP-sensitive potassium channel opener and nitric oxide donor has dual protective effects on myocardium.Recent studies have also shown that nicorandil intravenously during perioperative period can reduce the occurrence of NR/SF during PCI and improve the prognosis.However,studies have shown that the effect of intravenous nicorandil on the hemodynamics of ACS patients should not be overlooked.Studies have shown that intravenous nicorandil(4-12 mg)reduces mean arterial pressure(5 to 15%),systemic vascular resistance(8 to 27%)and left ventricular end-diastolic pressure(8 to18%)significantly in ACS patients.The effect of nicorandil on blood pressure is dose-dependent,and the chang of the drip-speed could also cause the fluctuation of blood pressure.In addition,intolerable headache is more common during nicorandil intravenously,occurres about 30% of patients.Therefore,in this study,we aim to explore whether taking high-dose of nicorandil orally before PCI can prevent NR/SF in patients with ACS,and whether it can achieve similar effects compared with nicorandil intravenously.ObjectivesAim to explore whether high dose nicorandil taking before PCI can decrease the incidence of NR/SF among the ACS patients.Whether continuous use of nicorandil with routine dosage after PCI can improve myocardial ischemia and prognosis of patients.MethodsThis study was a restrospective cohort trial,which was conducted among 120 patients with acute coronary syndromes.They were divided into control group A,group B receiving 12 mg nicorandil intravenously and group C receiving 20 mg orally.Mean follow-up was half a year.All patients were received active comprehensive treatment of coronary heart disease.On the basis of comprehensive treatment,group B and group C were given nicorandil 5 mg three times a day for 6 months,with an average follow-up of half a year.The TIMI flow grade of infarct-related artery,corrected TIMI frame count(c TFC),peak levels of serum c Tn I and CK-MB among the three groups were analyzed.Cardiac function was followed up for one month,three months and half a year after PCI.And the occurrence of adverse events(including recurrent angina pectoris,recurrent myocardial infarction,malignant arrhythmia,heart failure,cardiac death,and non cardiac death)were observed half a year after PCI among the three groups.Results1.There was no significant difference in TFG after PCI among the three groups(P>0.05),but the c TFC in group B and C was significantly lower than that in group A [18.07±1.609 vs.14.44±1.424 vs.14.40±1.714,P<0.05],while there was no significant difference between group B and group C(P > 0.05).2.The incidence of NR/SF in group B and group C was lower than that in control group [30.0% vs.17.3% vs.20.0%,P<0.05].There was no significant difference between group B and group C(P > 0.05).3.The peaks of CK-MB and c Tn I in group B and group C were lower than those in control group[CK-MB:(75.2±29.071)ng/ml vs.(63.40±17.1435)ng/ml vs.(57.07±20.712)ng/ml,P<0.05][c Tn I:(28.50±9.515)ng/ml vs.(16.28±6.571)ng/ml vs.(15.92±4.764)ng/ml,P<0.05],but there was no statistic significant difference betwe en group B and group C(P> 0.05).4.LVEF increased in group B and group C at 3 months after operation[(50±10)% vs(56±9)% vs.(57±7)%,P < 0.05],and LVEDV decreased significantly [(113±23)ml vs.(105±21)ml vs.(105±25)ml,P<0.05],but there was no statistic significant difference half a year,compared with group A(P> 0.05).5.The incidence of MACEs in group B and C were lower than that in control group A half a year after PCI[32.4% vs.10.5% vs.10.5%,P<0.05].The value of the admission by heart failure half a year was decreased than that of group A [13.5% vs.5.2% vs.5.2%,P< 0.05],and there was no significant difference between group B and group C(P>0.05).ConclusionsHigh dose of nicorandil before PCI could prevent the incidence of NR/SF during PCI,and continuous use after PCI could reduce myocardial injury and improve cardiac function in patients with ACS,reduce the occurrence of MACEs events in patients with ACS.