经微导管注射硝酸甘油治疗急性ST段抬高型心肌梗死患者冠状动脉无复流的效果观察

Effect of microcatheter injection of nitroglycerin on coronary artery no-reflow in patients with acute ST-segment elevation myocardial infarction

目的探讨经微导管注射硝酸甘油对急性ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入(PCI)术中冠状动脉无复流的即刻疗效及短期预后的影响。方法采用前瞻性随机对照研究设计,连续入选2016年7月至2017年12月首都医科大学附属北京安贞医院收治的急诊PCI术中发生冠状动脉无复流的STEMI患者104例。采用随机数字表法将患者分为观察组(经微导管注射硝酸甘油200μg)和对照组(经指引导管注射硝酸甘油200μg),各52例。主要观察指标为用药后靶血管心肌梗死溶栓试验(TIMI)血流分级及校正的TIMI血流帧数(CTFC);次要观察指标包括PCI围术期相关并发症,术后随访3个月再发心肌梗死、靶血管血运重建、死亡等心血管不良事件,以及心脏功能指标左心室射血分数(LVEF)和左心室舒张末期内径(LVEDD)值。结果观察组用药后即刻靶血管TIMI血流较对照组明显改善,TIMI3级比例明显高于对照组[78.8%(41/52)比53.8%(28/52)],CTFC明显少于对照组[(27±18)帧比(39±19)帧],差异均有统计学意义(均P<0.01)。2组围术期低血压、心动过缓、室性心动过速/心室颤动发生率比较,差异均无统计学意义(均P>0.05)。随访3个月时,2组靶血管血运重建率和死亡率、LVEF和LVEDD比较,差异均无统计学意义(均P>0.05)。结论PCI术中经微导管注射硝酸甘油可以改善STEMI患者术后即刻冠状动脉血流,但并不改善短期预后。

Objective To observe the effect of nitroglycerin injection by microcatheter on the immediate efficacy and short-term prognosis in ST-segment elevation myocardial infarction( STEMI) patients suffering from coronary artery no-reflow during percutaneous coronary intervention( PCI). Methods A total of 104 patients with STEMI who had coronary artery no-reflow during PCI were enrolled from July 2016 to December 2017 in Beijing Anzhen Hospital,Capital Medical University. The patients were randomly divided into observation group treated by microcatheter injection of nitroglycerin 200 μg and control group treated by nitroglycerin injection using guiding catheter,with 52 cases in each group. Priminary endpoints were thrombolysis in myocardial infarction( TIMI) flow grade and corrected TIMI frame count( CTFC) after nitroglycerin injection. Secondary endpoints included perioperative complications,adverse cardiovascular events such as recurrent myocardial infarction,target vessel revascularization,death,and cardiac function indicators including left ventricular ejection fraction( LVEF) and left ventricular end-diastolic diameter( LVEDD) in 3 months after PCI. Results After nitroglycerin injection,the success rate of correcting no-reflow( TIMI grade 3) in observation group was higher[78. 8%( 41/52) vs 53. 8%( 28/52) ] and CTFC was less[( 27 ± 18) frames vs( 39 ± 19) frames]than those in control group( both P < 0. 01). No significant differences were observed regarding perioperative hypotension,bradycardia and ventricular tachycardia/ventricular fibrillation between groups( all P > 0. 05). No significant differences were documented in 3-month revascularization rate,mortality,LVEF and LVEDD between groups( all P > 0. 05). Conclusion Microcatheter injection of nitroglycerin can immediately correct coronary no-reflow in STEMI patients undergoing PCI,but it shows no significant benefit for the short-term prognosis.