Study On Intraoperative And Postoperative Safety And Myocardial Protection Of STEMI Patients With Preoperative Load Of Common Heparin Combined With Nicorandil

Background: The acute ST segment elevation myocardial infarction(STEMI)patients have high morbidity and mortality.If blood flow is not restored in time,the heart will lead to irreversible cell damage and necrosis.Emergency percutaneous coronary intervention(PCI)is the fastest and most effective treatment for STEMI.However,successful revascularization does not necessarily maintain adequate myocardial reperfusion,which is called no flow/slow flow phenomenon or microcirculation disturbance.During PCI,the entry of guide wire,balloon and stent mechanical expansion may lead to plaque rupture,and then cause the activation of coagulation system,leading to the aggregation of endothelial cells,thrombin and platelets.These debris cause microvascular obstruction and microcirculation disturbance.Among them,the activation of coagulation system plays an important role.Unfractionated heparin is the most commonly used anticoagulant drug in PCI.It can effectively block the cascade of coagulation cascade,prevent the further occurrence and development of thrombosis,promote thrombolysis,and even autolysis of infarct related artery,shorten the total ischemic time,and improve the prognosis of patients.Nicorandil is a mixture of potassium channel opener and nitrate,which can dilate coronary artery,increase coronary blood flow,improve the rate of culprit blood flow,effectively improve microcirculation perfusion,reduce myocardial injury in emergency PCI patients,so as to achieve myocardial protection.Objacyive:To investigate whether loading dose of unfractionated heparin combined with nicorandil can further improve myocardial protection in patients with STEMI during and after emergency PCI,and has certain safety.Methods: 120 patients with acute ST segment elevation myocardial infarction in our hospital from November 2019 to December 2020 were selected.They were randomly divided into 4 groups: loading dose of unfractionated heparin combined with nicorandil group(group A),loading dose of unfractionated heparin group(group B),nicorandil group(Group C)and conventional drug group(Group D).All the four groups received direct emergency PCI treatment within 12 hours after onset.On the basis of conventional treatment,patients in group a received intravenous injection of loading dose of unfractionated heparin 4000 U immediately after diagnosis in emergency room Nicorandil 4mg was injected intravenously immediately after the catheterization.On the basis of routine treatment,patients in group B were given intravenous injection of4000 U unfractionated heparin immediately after diagnosis in emergency room.On the basis of routine treatment,patients in group C received intravenous injection of nicorandil 4mg immediately after reaching the catheter room.The patients in group D were treated with conventional drugs.The general information,admission condition and related interventional information of the four groups were collected and recorded.APTT levels before and immediately after treatment,bleeding events during hospitalization,no reflow / slow flow rate,CK-MB and c Tn I levels before and 24 hours after treatment,and NT pro BNP levels before and 1 week after treatment were detected.Results: Before treatment,APTT was performed in combination group,loading dose unfractionated heparin group,nicorandil group and conventional group(26.86±7.01)seconds,(26.59±6.84)seconds,(27.95±8.41)seconds,(26.64±7.81)seconds,there was no significant difference among the four groups.The APTT value immediately after operation in the four groups was(38.43±7.14)seconds,(37.66±7.66)seconds,(36.41±6.72)seconds,(35.92±6.42)seconds,but there was no significant difference among the four groups(P>0.05);There was no intracranial hemorrhage and gastrointestinal bleeding in the four groups.The total incidence of bleeding events in the combined medication group,loading heparin group,nicorandil group and conventional medication group were 6.7%,3.3%,6.7% and 3.3%,respectively.There was no significant difference in the incidence of total bleeding events among the four groups;The incidence of no reflow / slow flow was lower in the combined group(3.3%)than that in the loading dose unfractionated heparin group(23.3%),nicorandil group(20.0%)and conventional group(26.7%)(P< 0.05);There was no significant difference in CK-MB and c Tn I levels among the four groups before treatment.The CK-MB value of the four groups 24 hours after operation was(40.66± 6.86)ng/ml VS(54.58±7.60)ng/ml,nicorandil group(57.64±6.90)ng/ml,and the loading dose of unfractionated heparin group and nicorandil group were(74.75±8.22)ng / ml,the difference was statistically significant(P<0.05);The level of c Tn I was(2.24±1.17)ng/ml,loading dose of unfractionated heparin group and nicorandil group were(3.33±0.87)ng/ml,(3.47±0.98)ng/ml,and the c Tn I level in the conventional treatment group was(4.21±0.73)ng/ml.the c Tn I level in the combination group was lower than that in the loading dose of unfractionated heparin group and nicorandil group,and the c Tn I level in the loading dose of unfractionated heparin group and nicorandil group was lower than that in the conventional group(P < 0.05);There was no significant difference in NT pro BNP level among the four groups before treatment(P>0.05),and the NT pro BNP level in the combination group was(566.30±117.09)pg/ml on the first four weeks after operation,loading dose of unfractionated heparin group(675.70±134.02)pg/ml,nicorandil group(669.90±148.21)pg/ml,conventional group(753.83±142.32)pg/ml The level of NT pro BNP in the combination group was lower than that in the loading dose of unfractionated heparin group and nicorandil group,and the level of NT pro BNP in the loading dose of unfractionated heparin group and nicorandil group was lower than that in the conventional treatment group(P < 0.05).Conclusion: The load of heparin combined with nicodil can reduce the incidence of no reflow / slow blood flow in emergency PCI in STEMI patients,reduce the myocardial injury markers CK MB,c Tn I,and also reduce NT pro BNP level,thus improving microcirculation perfusion of myocardial cells,reducing the scope and quantity of necrotic myocardium,further improving the cardiac function of STEMI patients and improving the prognosis of patients,It is worth popularizing in clinic.