Effect Of Intravascular Injection Of Nicorandil On STEMI Patients After PPCI

Objective:To explore the effect of intracoronary injection of nicorandil and nitroglycerin before stent implantation for STEMI patients undergoing primary percutaneous coronary intervention.Methods: 150 STEMI patients undergoing PPCI were randomly divided into nitroglycerin group(n=75)and nicorandil group(n=75).Patients in the nitroglycerin group received 250?g nitroglycerin through intracoronary injection before PPCI,and the nicorandil group received 2mg nicorandil.After PCI,all patients underwent coronary angiogram,calculated the rate of slow-reflow /no-reflow immediately,Plasma levels of cardiac troponin T(TNT),creatine kinase-MB(CK-MB)were determined before and at 6,18,and 24 h after PCI.Record the incidence of malignant arrhythmia,shock and Bleeding.The left ventricular ejection fractions(LVEF)and high sensitivity C reactive protein(hs-CRP)were recorded before and 3 months after PCI.Results:(1)There was no significant difference in the location of MI and the opening time of criminal vessels.A significant difference in the rate of slow-reflow /no-reflow(6.7% vs.26.7%,P<0.01)between the two groups.(2)The levels of TNT,CK-MB in the nicorandil group were significantly reduced compared to the nitroglycerin group(all P<0.05).(3)Administration of nicorandil markedly reduced inflammatory response,but obviously increased LVEF at 3 months after PCI(P=0.023,P=0.042).(4)The levels of hs-CRP and TNF-? were significantly lower in nicorandil group(3.990±0.750 vs.5.525±0.712,P=0.023;13.27±0.615 vs.17.75±0.75,P=0.023)?(5)The levels of ET-1 in nicorandil group was significantly lower than that of nitroglycerin group,NO and FMD were significantly higher than nitroglycerin group(77.6±10.51 vs.86.7±9.21,71.6±10.51 vs.65.8±10.51,12.9±2.41 vs.11.5±1.81,P<0.05).(6)Nicorandil markedly reduced the incidence of malignant arrhythmia and shock(P=0.011,0.046).Conclusions:(1)Nicorandi can reduce the rate of slow-reflow/no-reflow than Nitroglycerine in STEMI patients injected in coronary before PPCI.(2)Nicorandi can reduce the rate of Blush grade < 2 than Nitroglycerine in STEMI patients injected in coronary before PPCI.(3)Nicorandi can reduce the myocardial cell injury,decrease 6 h,18 h,24 h TNT level,18 h CK-MB level than Nitroglycerine in STEMI patients injected in coronary before PPCI.(4)Nicorandil can reduce myocardial injury and better preserve cardiac LVEF than Nitroglycerine in STEMI patients injected in coronary before PPCI.(5)Nicorandil can reduce inflammation,decrease hsCRP,TNF-a level than Nitroglycerine in STEMI patients injected in coronary before PPCI.(6)Nicorandil can increase vascular diastolic function,reduce ET-1,and increase the NO and FMD level than Nitroglycerine in STEMI patients injected in coronary before PPCI.(7)The treatment of Nicorandil in STEMI patients injected in coronary before PPCI was not increasing the incidence of bleeding,rate of incidence of malignant arrhythmia and shock comparing to Nitroglycerin.