| Objective:To investigate the preventive effect of intracoronary injection of nicorandil through thrombus aspiration catheter on slow flow or no reflow in ST-segment elevation myocardial infarction(STEMI)patients with high thrombus load undergoing emergency percutaneous coronary intervention(PCI),and its impact on myocardial injury,cardiac function and short-term prognosis.Methods:The study adopted a prospective,randomized,and controlled research method.From March 2019 to September 2020,80 patients with high thrombotic load admitted to our hospital due to STEMI and emergency PCI were selected as the research objects.According to the selected treatment,the patients were randomly divided into two groups,with 40 cases in each group.After angiography,thrombus in infarct related artery(INR)was aspirated by thrombus aspiration catheter in control group,and then tirofiban was injected into coronary artery.On the basis of the control group,the experimental group was given nicorandil 2mg at the lesion of INR through thrombus aspiration catheter,and then PCI was performed.The general clinical data(such as age,gender,etc.)of the two groups were collected and recorded,and the thrombolysis in myocardial infarction(TIMI)test before and after treatment were recorded,the incidence of slow flow or no reflow,cardiac troponin I(c Tn I)and creatine kinase isoenzyme(CK-MB)before surgery and 24 hours after onset,N-Terminal Pro-Brain Natriuretic Peptide(NT-pro BNP)before operation and 7 days after surgery,left ventricular ejection fractions(LVEF)before and 7 days after surgery,major adverse cardiovascular events(MACE)incidence rate of 12 weeks after operation were recorded.Results:There was no significant difference in TIMI blood flow classification between the two groups before treatment(X~2=0.213,P=0.644),and the difference in TIMI blood flow classification between the two groups after treatment was statistically significant(X~2=4.021,P=0.045).The incidence of slow blood flow or no-reflow in the experimental group was lower than that in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in CK-MB between the two groups of patients before operation(t=0.922,P=0.360),and no significant difference in c Tn I(t=1.225,P=0.224).CK-MB(56.15±15.15)ng/m L in experimental group was lower than CK-MB(80.26±13.87)ng/m L in control group at 24 hours of onset,c Tn I(3.41±1.28)ng/m L in experimental group was lower than c Tn I(4.23±1.85)ng/m L in control group at 24hours of onset.There was a difference in CK-MB between the two groups at 24 hours of onset(t=0.753,P=0.454),and a difference in c Tn I at 24 hours of onset(t=2.316,P=0.023),which was statistically significant(P<0.05).There was no significant difference in NT-pro BNP between the two groups before operation(t=0.904,P=0.485)(P>0.05).NT-pro BNP of experimental group(604.35±184.45)pg/m L was lower than that of control group(712.05±154.09)pg/m L 7 days after operation(t=2.834,P=0.006),with statistical significance(P<0.05).LVEF 7days after operation in experimental group(59.60±6.35)%was higher than that in control group(54.35±6.83)%.There was a difference between the two groups in the 7-day LVEF(t=3.561,P=0.001),statistically significant(P<0.05).The incidence of mace in experimental group was lower than that in control group,and the difference was statistically significant(P<0.05).Conclusion:Intracoronary injection of nicorandil through thrombus aspiration catheter can effectively prevent the occurrence of slow flow or no reflow phenomenon in STEMI patients with high thrombus load undergoing emergency PCI.It has the functions of reducing myocardial injury,improving cardiac function and short-term prognosis. |
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