Effect Of Intravenous Application Of Nicorandil On Myocardial Infarction Area In Patients With STEMI During PCI

Objective: This study aims to evaluate the effectiveness and safety of nicorandil in improving the myocardial infarction area in patients with acute myocardial infarction through prospective,randomized,and controlled studies,and to provide evidence-based support for the optimization of PCI treatment.Methods: This study selected The Sixth Affiliated Hospital of Guangxi Medical University from December 01,2018 to December 31,2019,and admitted to the Department of Cardiology and based on the third edition jointly developed by ESC,ACCF,AHA,and WHF in 2012."Global definition of myocardial infarction" for patients diagnosed with acute ST-segment elevation myocardial infarction(STEMI),patients who obtained informed consent and confirmed to meet the inclusion and exclusion criteria after angiography,were numbered in order of admission time and randomized the study subjects using random number table method Divided into experimental group(group A)and control group(group B),all patients received oral aspirin load(300 mg)once before primary PCI and maintained 100 mg/qd thereafter;oral load ticagrelor Lo(180 mg)once,and thereafter maintain 90 mg/bid.Before the first balloon dilatation or 1 minute before stent implantation,the experimental group was given intravenous bolus nicorandil.After the bolus injection was completed,intravenous nicorandil was given for maintenance;the control group was only balloon dilated And stent placement.In addition,all patients’ conventional drug treatment plans are formulated according to the latest STEMI diagnosis and treatment guidelines and changes in patients’ conditions.Record the area of myocardial infarction on the 7th and 180 th days after PCI,the area of myocardial edema on the 7th day after operation,the changes of myocardial enzymes and troponin before and after the operation,the ST segment changes on the electrocardiogram,and the 7th day Left ventricular ejection fraction,preoperative and postoperative TIMI blood flow,intraoperative and postoperative24 h heart rhythm and blood pressure,and composite cardiovascular events during the study period.Results:1.A total of 120 STEMI patients in this study met the inclusion criteria.The enrolled patients were numbered in the order of admission time,and the random number table method was used to randomly divide the study subjects into 60 cases in group A and 60 cases in group B,including 1 patient in group A.Cerebral hemorrhage was discharged from the hospital on the first postoperative day and was excluded.Finally,59 patients in group A and 60 patients in group B were excluded.During the follow-up period,no patients were lost to followup.There was no statistically significant difference between the two groups of clinical basic data such as hypertension,smoking,diabetes,GPⅡb/Ⅲa receptor antagonist use rate,D2 B time,time from onset to hospital arrival(all P>0.05).2.The myocardial infarction area of group A on the 7th day postoperative was lower than that of group B,but the difference was not statistically significant(3.2±0.8,3.5±1.0,P>0.05,respectively).3.The myocardial edema area of group A was lower than that of group B on the 7th day postoperative,but the difference was not statistically significant(4.1±1.2,4.4±1.0,P>0.05,respectively).4.There was no significant difference in preoperative myoglobin(Mb),creatine kinase isoenzyme(CK-MB),and hypersensitivity troponin T(c Tn T-hs)between the two groups of patients(all P>0.05).Postoperative myoglobin(Mb)peak in group A was significantly lower than that in group B(311.48±235.31,503.71±564.18,P<0.05,respectively),and peak postoperative CK-MB in group A was significantly lower than that in group B(average grades 48.29,71.52,P<0.01,respectively),the peak value of postoperative hypersensitivity troponin in group A was significantly lower than that in group B(average grades 49.12,70.70,P<0.01).5.There was no statistically significant difference in the ST segment fall rate of the electrocardiogram immediately after the operation and the ST segment fall rate of 120 min after the operation(all P>0.05).6.The left ventricular ejection fraction(LVEF%)of patients in group A was lower than that in group B on the 7th day postoperative,but the difference was not statistically significant(55.2±4.8,53.4±7.7,P<0.05,respectively).7.The difference in the incidence of slow blood flow/no-reflow between the two groups was not statistically significant(P>0.05).8.There was no significant difference in the incidence of malignant arrhythmia and hypotension between the two groups of patients during operation and 24 hours after operation(P>0.05).9.After 180 days of postoperative follow-up,no MACE occurred in either group.10.The left ventricular ejection fraction(LVEF%)of patients in group A was significantly lower than that in group B on the 180 th day postoperative(58.1±6.2,54.1±6.9,P < 0.01,respectively).11.The myocardial infarction area of group A on the 180 th day postoperative was significantly lower than that of group B(2.7±1.0,3.3±1.0,P<0.01,respectively).Conclusion: In patients with STEMI,intravenous administration of nicorandil during PCI perioperative period can effectively reduce the area of myocardial infarction,effectively reduce myocardial damage,without increasing the incidence of malignant arrhythmia and hypotension during medication,and without increasing the compound heart during the study period.The incidence of vascular events.Intraperitoneal application of nicorandil during PCI is expected to become a new treatment option.