The Effect Of Prophylactic Application Of Alprostadil During Percutaneous Coronary Interventional Therapy On The Coronary No Reflow In Patients With Chronic Total Occlusive Disease

Objective: The purpose of this study was to investigate the effect of prophylactic application of alprostadil during percutaneous coronary intervention(PCI)on the coronary no reflow(CNR)in patients with chronic total occlusion(CTO)disease and to compare it with soudium nitroprusside.Methods: Patients admitted to the Third Hospital of Hebei Medical University from October 2017 to October 2019 who were confirmed by coronary angiography to have complete occlusion of a single main vessel(vessel diameter ?2.5mm,TIMI blood flow?1 grade,collateral circulation)and whose course of disease lasted more than 3 months were selected for successful revascularization.The patients were randomly divided into alprostadil group and soudium nitroprusside group by random number table method.On the basis of general treatment,alprostadil group was injected with alprostadil twice(2?g/time)at the distal end of the coronary artery occlusion by microcatheter after successful balloon predilation during CTO-PCI.In the soudium nitroprusside group,sodium nitroprusside was injected 2 times in the same route,200?g/time.Thrombolysis in myocardial infarction(TIMI),corrected TIMI frame count(c TFC),TIMI myocardial perfusion grade(TMPG)and the incidence of CNR were observed in the two groups.Blood samples were collected before operation and 2 hours and 3 months after operation to detect the level of n-terminal pro-brain natriuretic peptide(NT-pro BNP).Blood samples were collected to check the level of cardiac troponin I(c TNI)before operation and 2 hours and 1 week after operation.Cardiac functional parameters,left ventricular end-systolic diameter(LVESD),left ventricular end diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF)were measured by color doppler echocardiography before and after 3 months of follow-up.Major adverse cardiovascular events(MACEs)of patients in both groups were recorded during hospitalization and during 3 months of follow-up.Results: 1.Basic data: In this study,a total of 64 patients with single-vessel CTO lesions and successful revascularization were selected,including 33 patients in the alprostadil group and 31 patients in the sodium nitroprusside group.There was no statistically significant difference between the two groups in gender,age,BMI,hypertension,diabetes,hyperlipidemia,history of myocardial infarction,history of PCI,history of smoking and family history of coronary heart disease(P>0.05).There was no statistically significant difference between the two groups in the basic drugs(aspirin,clopidogrel,tigravil,beta blockers,diuretics,cardiac glycosides,ace inhibitors or ace blockers)(P>0.05).There were no statistically significant differences in NYHA cardiac function classification,collateral circulation classification,target vessel and occlusive vessel segment length between the two groups(P>0.05);2.Comparison of coronary angiography data and the incidence of no reflow: There was no statistically significant difference in the final TIMI blood flow grading,c TFC and TMPG grading between the two groups(P>0.05).There was no statistically significant difference in the incidence of no reflow between the two groups(P>0.05);3.Comparison between NT-pro BNP and c TNI: There was no statistically significant difference in the level of NT-pro BNP between the two groups before and after 2 hours and 3 months of follow-up(P>0.05).There was no significant difference in the level of c TNI between the two groups before surgery and 2 hours and 1 week after surgery(P>0.05);4.Comparison of cardiac function indicators: There was no statistically significant difference in preoperative LVEF,LVEDD and LVESD between the two groups(P>0.05).LVEF,LVEDD and LVESD of patients in the two groups were improved in the 3 months of follow-up after surgery compared with those before surgery,and the differences between the two groups were not statistically significant(P>0.05);5.Comparison of follow-up results: There was no statistically significant difference in the incidence of MACEs between the two groups during hospitalization and within 3 months of follow-up(P>0.05).Conclusion: In CTO-PCI,intra-coronary injection alprostadil via microcatheter is not worse than soudium nitroprusside.