尼可地尔对急性ST段抬高型心肌梗死的老年患者直接介入术后血流灌注及预后的影响

Effect of nicorandil on myocardial perfusion and outcome in elderly acute STEMI patients after primary PCI

目的观察冠状动脉内预防性注射尼可地尔对老年急性ST段抬高型心肌梗死(STEMI)的患者直接PCI(PPCI)术后心肌血流灌注及预后的影响。方法前瞻性纳入我院行PPCI的老年STEMI患者174例,随机分为尼可地尔组、硝普钠组和对照组,每组58例,分别于支架置入前冠状动脉内推注尼可地尔4mg、硝普钠200μg、0.9%生理盐水10ml。观察各组主要终点事件[校正TIMI帧数(cTFC),术后慢血流及无复流的发生率]及主要不良心血管事件的发生。结果尼可地尔组、硝普钠组及对照组术后即刻cTFC[(20.4±8.1)帧vs (25.5±7.6)帧vs(28.2±12.0)帧]、术后慢血流或者无复流发生率(6.9%vs 13.8%vs 24.1%)、术后90min心电图ST段回落不良发生率(8.6%vs 20.7%vs 27.6%)、再灌注心律失常发生率(17.2%vs 31.0%vs 39.7%)、术后TIMI<3级(10.3%vs 20.7%vs 29.3%)及cTnI[(7.5±1.8)μg/L vs(8.5±2.3)μg/L vs(12.1±3.2)μg/L]比较,差异有统计学意义(P<0.01,P<0.05)。多因素logistical分析结果显示,冠状动脉内注射尼可地尔是术后发生慢血流或者无复流的保护因素(95%CI:0.13~1.19,P=0.038),可降低术后cTFC(95%CI:0.14~0.52,P=0.000)。3组主要不良心血管事件发生率比较差异无统计学意义(P>0.05)。结论冠状动脉内预防性注射尼可地尔可改善老年急性STEMI患者PPCI术后心肌血流灌注水平,但不改善短期临床预后。

Objective To study the effect of intracoronary nicorandil injection on myocardial perfusion and outcome in elderly acute STEMI patients after primary PCI.Methods One hundred and seventy-four elderly acute STEMI patients who underwent primary PCI in our hospital were randomly divided into nicorandil treatment group,sodium nitroprusside treatment group and control group(58 in each group),and received 4 mg introcoronary nicorandil,200μg introcoronary sodium nitroprusside and 10 ml introcoronary 0.9% normal saline before stenting.The major end point events(cTFC and incidence of slow flow or no reflow)and MACE were recorded after primary PCI.Results The immediate cTFC,incidence of slow flow or no reflow,90 min incidence of ST segment reduction on ECG,incidence of reperfusion-induced arrhythmia,TIMI<3 and serum cTnI level were significantly lower in nicorandil treatment group than in sodium nitroprusside treatment group and control group after primary PCI(P<0.05,P<0.01).Multivariate logistic regression analysis showed that intracoronary nicorandil injection was a protecting factor for slow flow or no reflow and could reduce cTFC after primary PCI(P<0.05,P<0.01).No significant difference was found in MACE among the 3 groups(P>0.05).Conclusion Intracoronary nicorandil injection can improve the myocardial reperfusion but not the short-term outcome in elderly STEMI patients after primary PCI.