Effect Of Nicorandil On Microcirculation And Prognosis In Chronic Total Occlusion Patients After Percutaneous Coronary Intervention

Objective:To observe the effects of immediate target intracoronary injection of nicorandil after coronary artery target vessel opening and continuous intravenously infused nicorandil 24 hours on microcirculation and prognosis after percutaneous coronary intervention(PCI)in Chronic Total Occlusion patients.Methods:The enrolled 83 cases of CTO receiving PCI in the Third Hospital of Hebei Medical University from October 2017 to September 2019 were randomized into nicorandil group with 41 cases,and control group with 42 cases.However,in the course of the study,there were 7 patients failed to be opened in nicorandil group,so 34 patients were finally included in statistical treatment in nicorandil group;in the control group,7 patients were failed to be opened,1 patient was lost to follow-up after PCI and 1 patient died of cardiogenic shock during the operation,so 32 patients were finally included in statistical treatment in control group.In nicorandil group,patients were treated with immediately target intracoronary injecting 4mg nicorandil with microcatheter after coronary artery target vessel opening,the control group was injected with 0.9% sodium chloride injection of the same volume,Then in the nicorandil group,nicorandil was intravenously infused at 8mg/h for 24 hours after PCI.The TIMI flow grade of infarct-related artery,corrected TIMI frame count(c TFC),TIMI myocardial perfusion grade(TMPG)at the end of PCI were observed.N-terminal pro-brain natriuretic peptide(NT-pro BNP)?CK-MB?c Tn I was measured before and at 24 h after PCI.Color Doppler echocardiography was used to calculate the left ventricular ejection fraction(LVEF)?Wall Motion Score Index(WMSI)?left ventricular end diastolic(LVED)before and at 3 months after PCI.The incidence of hypotension during PCI?microcirculation disorder postoperative prognosis after PCI were observed.Results: there were significant differences in the corrected TIMI flow grade of infarct-related artery ? TIMI myocardial perfusion grade(TMPG)After PCI between the two groups,however The TIMI flow grade of infarct-related artery did not differ significantly(P>0.05).There was no statistically significant difference in preoperative N-terminal pro-brain natriuretic peptide(NT-pro BNP)?CK-MB?c Tn I and creatinine levels between the two groups.Postoperative N-terminal pro-brain natriuretic peptide(NT-pro BNP)? CK-MB and c Tn I in the nicorandil group were significantly lower than those in the control group(P < 0.05),while there was no statistically significant difference in postoperative creatinine levels between the two groups(P < 0.05).There was no statistically significant difference in the left ventricular ejection fraction(LVEF)?Wall Motion Score Index(WMSI)?left ventricular end diastolic(LVED)before PCI between two groups(P>0.05);after PCI,the left ventricular ejection fraction(LVEF)?left ventricular end diastolic(LVED)were significantly improved compared with those before PCI between two groups(P<0.05),but Wall Motion Score Index(WMSI)did not(P>0.05).During the PCI,the incidence of hypotension in the control group and nicorandil group was 6.2%(2/32)and 0,respectively,which showed no significant differences between two groups(P=0.231>0.05),Patients with hypotension in the control group were treated by dopamine.The incidence of MACEs 3 months after PCI was 2.9%(1/34)and 12.5%(4/32),respectively,with differed no significant between two groups(P=0.16>0.05).Conciusions:Immediate target intracoronary injection of nicorandil after coronary artery target vessel opening and continuous intravenously infused nicorandil 24 hours can effectively improve the myocardial perfusion and cardiac function,reduce the incidence of microcirculation disorders,and improve prognosis.