| Objective: By analyzing the improvement of microcirculation in patients with acute ST segment elevation myocardial infarction（STEMI）treated with PCI after intervention with nicorandil,to explore the mechanism of coronary microcirculation disorder in patients with STEMI and the effect of nicorandil on the prognosis of patients.Methods:From January 2019 to December 2020,120 patients with first-time acute ST-segment elevation myocardial infarction who underwent emergency PCI in the Department of Cardiovascular Medicine,Jinqiu Hospital,Liaoning Province were selected and divided into experimental group and control group according to random number table.60 cases.Both groups were given conventional treatment after operation.On the basis of conventional treatment,the experimental group was given intracoronary injection of 4 mg nicorandil during PCI,and 6 mg/h of continuous peripheral intravenous infusion of nicorandil for 24 hours after operation.After 24 hours,oral nicorandil 5 mg（3 times/d）was given for 1 month.The control group was the same as the experimental group except that no nicorandil was used.The postoperative coronary blood flow and myocardial blood perfusion were compared between the two groups,including the immediate postoperative TIMI blood flow classification,the immediate postoperative CTFC,the ratio of patients with ST segment fall within 2 hours after surgery,and the incidence of adverse cardiovascular events during hospitalization.All patients were followed up for 6 months,the echocardiographic indexes including LVESV,LVEDV,LVEF,WMSI,LVEDD,and LVESD were compared between the two groups before operation and six months after operation.The prognosis of the two groups,adverse cardiovascular events,was compared,and the risk factors affecting the occurrence of adverse cardiovascular events were analyzed.Results: 1.The proportion of patients with TIMI blood flow grade III immediately after operation in the experimental group was higher than that in the control group（P<0.05）,and the proportion of patients with CTFC and CTFC>40 immediately after operation were lower than those in the control group（P<0.05）.The ratio of patients with ST segment fall within 2 hours was higher than that of the control group（P<0.05）.During hospitalization,there were no patients with target lesion revascularization or death in both groups.The proportion of patients with angina pectoris and aggravation of heart failure in the experimental group and the control group was not statistically different at 24 hours after operation（P>0.05）.The proportion of patients was lower than that of the control group（P<0.05）.2.There was no significant difference in the preoperative echocardiographic examination indexes LVESV,LVEDV,LVEF,WMSI,LVEDD and LVESD between the two groups（P>0.05）.The LVESV,LVEDV and WMSI of the group were lower than those of the control group（P < 0.05）,the LVEF was higher than that of the control group（P < 0.05）,and the LVEDD and LVESD were lower than those of the control group（P < 0.05）.3.The recurrence rate of myocardial infarction,heart failure rate,malignant arrhythmia rate and death rate in the experimental group within 6 months after operation were lower than those in the control group（P<0.05）.Univariate analysis showed that the risk factors for adverse cardiovascular events during follow-up within6 months after operation were related to disease of more than 3 vessels,postoperative TIMI blood.Flow grade II,postoperative CTFC>40,no ST segment fall after 2 h,adverse cardiovascular events during hospitalization,and non-use of nicorandil were related（P<0.05）.After multivariate analysis,it was found that more than 3 vessels disease,no use of nicorandil were independent risk factors for adverse cardiovascular time during follow-up（P<0.05）.Conclusion: 1.Nicorandil use in STEMI patients undergoing PCI can effectively improve coronary microcirculation status and improve the level of myocardial perfusion.2.Nicorandil has a protective effect on cardiac function in STEMI patients undergoing PCI and may reduce the occurrence of mace events. |
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