摘要
Objective To investigate whether intracoronary administration of anisodamine before myocardial reperfusion could reduce/avoid no-reflow phenomenon and improve myocardial reperfusion in acute inferior myocardial infarction(AIMI)patients undergoing primary percutaneous coronary intervention(PCI).Methods In this single-center prospective randomized controlled study,we enrolled patients suffering from AIMI within 12 hours undergoing primary PCI from January 2014 to March 2016.Eligible patients were randomly divided into two groups:Anisodamine group,72 cases,intracoronary administration of anisodamine 1500 μg/3 ml before myocardial reperfusion;Control group,71 cases,intracoronary administration of saline 3 ml before myocardial reperfusion.All patients received transradial coronary intervention.Quantitative coronary angiography tissue perfusion indexes [including the initial thrombolysis in myocardial infarction(TIMI),postoperative TIMI,and TIMI myocardial perfusion grade(TMPG)]were judged by two interventional cardiologists.Myocardial infarct size was estimated by peak levels of CK-MB and cTnI.Inflammatory markers including hs-CRP,IL-6,P-selectin and ICAM-1 were tested before and 24 h after PCI.Electrocardiography was recorded on admission and at 90 min after PCI.A decrease in the sum of ST-segment elevation by≥70% was categorized as complete ST-segment resolution(STR)and used as an index of myocardial reperfu-sion and the primary end point of this study.Major ad-verse cardiovascular events were evaluated within 30 days and 6 months after discharge.Multivariate logistic regression analysis was used to explore the related factors associated with complete STR.Results After PCI,the proportions of TIMI 3(91.7% vs 77.5%,P=0.03)and TMPG 3(80.6% vs 60.6%,P=0.01)were significantly higher in anisodamine group than in control group.ST segments were significantly resolved,STE reduced from(10.0±4.2)mm to(5.8±1.7)mm in anisodamine group.The percentage of complete STR was statistically higher in anisodamine group than in control group(69.4% vs 50.7%,P=0.03).After PCI,there were 4 cases of bradycardia in anisodamine group and 42 cases bradycardia in control group.Multivariate Logistic regression analysis showed that low coronary diastolic pressure(OR=1.298,95% CI:1.155-1.457,P<0.01)and slow heart rate(OR=1.251,95% CI:1.087-1.440,P=0.002)were independent risk factors of incomplete STR,while anisodamine administration was a protective factor for complete STR(OR=0.059,95% CI:0.014-0.255,P<0.01).At 24 h after PCI,the levels of inflammatory markers increased in both two groups,but were significantly lower in anisodamine group compared to control group(P<0.01).Within 30-day after PCI,there was one patient developing new MI and another patient needing target vessel revascularization in control group.At the end of 6-month follow up,one MACE and 5 MACEs occurred in anisodamine group and control group respectively(P=0.21).Conclusion Intracoronary administration of anisodamine before reperfusion is safe and can reduce no-reflow and improve myocardial perfusion in AIMI patients undergoing PCI.
作者
LI Wei
李伟(Dept Cardiol,2nd Hosp,Hebei Med Univ)
