尼可地尔对急性非ST段抬高型心肌梗死PCI术中慢血流的疗效观察

The effect of nicorandil on slow-flow phenomenon in PCI in patients with non-ST segment elevated myocardial infarction

目的观察冠脉内注射尼可地尔对于改善急性非ST段抬高型心肌梗死(NSTEMI)经皮冠状动脉介入治疗术(PCI)术中慢血流/无复流的情况。方法选取急性非ST段抬高型心肌梗死(NSTEMI)患者159例,根据PCI术后靶病变血管TIMI血流分为2组,TIMI≤2级为慢血流/无复流组(31例),TIMI血流3级为复流正常(reflow)组(128例)。比较2组患者的一般临床资料、PCI治疗后梗死相关血管(IRA)的TIMI血流分级、校正的TIMI血流计帧数(CTFC)和TIMI心肌灌注分级、血栓征象、病变血管数目及主要心脏不良事件(MACE)发生情况。给予慢血流/无复流组的患者冠脉内注射尼可地尔,观察用药前后血流改善情况。慢血流/无复流的影响因素采用多因素Logistic回归分析。结果慢血流/无复流组吸烟史、糖尿病史、患高脂血症、术中发生低血压、多支架(≥3个)及术后使用替罗非班者的比例,CTFC、有血栓征象的比例明显高于复流正常组患者(P<0.05);2组患者术中心率、IRA分布、病变血管支数差异无统计学意义。2组MACE发生率、术后7 d左室射血分数差异无统计学意义;慢血流/无复流组应用尼可地尔后,患者TIMI血流3级比例,术后c TFC、TMPG 3级比例均明显高于应用尼可地尔前(P<0.05)。有吸烟史、糖尿病病史、多支架(≥3个)、术中低血压、血栓征象是冠脉发生慢血流/无复流的危险因素。结论尼可地尔可显著改善NSTEMI患者PCI术中慢血流/无复流。

Objective To observe the effect of nicorandil on slow-flow phenomenon in percutaneous coronary intervention(PCI)in patients with acute non-ST segment elevated myocardial infarction(NSTEMI).Methods A total of159NSTEMI patients were enrolled.Based on the TIMI flow of target lesion blood vessels after PCI,patients were divided into two groups.There were31cases in no flow/slow flow group(TIMI≤2),and128cases in normal group(TIMI=3).The general clinical data,immediate TIMI flow grade of infarct-related artery(IRA)after PCI treatment,post-operative corrected TIMI frame count(CTFC),TIMI myocardial perfusion grade(TMPG),thrombolysis in myocardial infarction signs of a blood clot,number of diseased vessels and major adverse cardiac events were compared between the two groups.The patients in no flow/slow flow group were given nicorandil,and changes of blood flow before and after treatment were observed.The influence factors of no flow/slow flow were analyzed by multifactor Logistic regression.Results The proportions of patients with history of smoking,the proportion of patients with diabetes history,the proportion of patients with hyperlipidemia,the proportion of patients with low blood pressure in operation,and the number of implanted stents,the proportions of patients took tirofiban in operation,post-operative CTFC,the proportions of patients with thrombosis signs were significantly higher in no flow/slow flow group than those in the normal group(P<0.05).There were no significant differences in heart rates in operation,IRA distribution and the number of lesion vessels between the two groups.There were also no significant differences in the incidence of MACE and left ventricular ejection fraction between the two groups.After the application of nicorandil,the proportion of patients with TIMI blood flow3and proportions of cTFC and TMPG were significantly higher than before treatment(P<0.05).Results showed that smoking history,history of diabetes,multiple stents(more than3),hypotension in PCI,and signs of blood clot were factors influencing the slow flow of coronary arteries.Conclusion Nicorandil can significantly improve the no flow/slow flow in PCI in patients with NSTEMI.