急性前壁心肌梗死术前应用尼可地尔对冠脉无复流影响的研究

Influence of preoperative nicorandil application on coronary no-reflow in patients with acute anterior myocardial infarction

目的:探讨术前应用尼可地尔对急性前壁心肌梗死患者急诊经皮冠状动脉介入治疗(PCI)后无复流的影响。方法:116例急性前壁心肌梗死患者,被随机分为常规治疗组(58例)和尼可地尔组(58例,在常规治疗基础上加用尼可地尔)。比较两组患者PCI后心肌梗死溶栓分级(TIMI)情况、无复流发生率、心电图ST段回落指数(STR)及主要不良心血管事件(MACE)发生率。结果:术后与常规治疗组比较,尼可地尔组梗死相关血管(IRA)TIMI3级比例(77.6%比91.4%)及术后2hSTR[(0.15±0.05)mm比(0.18±0.05)mm]明显增加,无再流发生率(13.8%比3.4%)和MACE发生率(17.2%比5.2%)明显降低(P<0.05或<0.01)。结论:术前应用尼可地尔,可减少术后无复流的发生率,改善心肌灌注,减少主要不良心血管事件发生率。

Objective:To explore influence of preoperative nicorandil application on coronary no-reflow during emergency percutaneous coronary intervention(PCI)in patients with acute anterior myocardial infarction(AAMI).Methods:A total of 116 AAMI patients were randomly and equally divided into routine treatment group and nicorandil group(received nicorandil based on routine treatment).TIMI grade,incidence rate of no-reflow,ECG ST-segment elevation resolution(STR)and incidence rate of major adverse cardiovascular events(MACE)after PCI were compared between two groups.Results:Compared with routine treatment group after PCI,there were significant rise in percentage of infarct related artery(IRA)TIMI grade 3(77.6%vs.91.4%)and STR on 2h after PCI[(0.15±0.05)mm vs.(0.18±0.05)mm],and significant reductions in incidence rates of no-reflow(13.8%vs.3.4%)and MACE(17.2%vs.5.2%)in nicorandil group after PCI,P<0.05 or<0.01.Conclusion:Preoperative nicorandil application can reduce incidence rate of no-reflow after PCI,improve myocardial perfusion and reduce incidence rate of major adverse cardiovascular events.