尼可地尔对介入治疗老年非ST段抬高型心肌梗死患者冠状动脉灌注的疗效评价

Efficacy of nicorandil on coronary perfusion in elderly with NSTEMI after interventional therapy

目的 探讨尼可地尔对行PCI的老年非ST段抬高型心肌梗死(NSTEMI)患者冠状动脉灌注的影响。方法回顾性分析2020年6月~2022年2月于解放军总医院第七医学中心心内科择期行PCI的老年NSTEMI患者180例,依据是否使用尼可地尔分为治疗组88例和对照组92例。比较2组患者治疗后血清肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)峰值、达峰时间、N末端B型钠尿肽前体(NT-proBNP)、PCI术后冠状动脉灌注情况,采用TIMI血流分级和校正的TIMI血流计帧数(CTFC)评价。采用ROC曲线分析发生无复流/慢血流(NR/SF)的预测效能。结果 治疗组治疗后cTnI峰值、CK-MB峰值、NR/SF发生率以及术后CTFC明显低于对照组,cTnI达峰时间和CK-MB达峰时间明显短于对照组(P<0.05,P<0.01)。同型半胱氨酸和D-二聚体升高是NSTEMI患者在PCI术后出现NR/SF的危险因素(P<0.05)。ROC曲线分析显示,同型半胱氨酸预测PCI术后发生NR/SF的ROC曲线下面积(AUC)为0.665(95%CI:0.556~0.775,P=0.010),D-二聚体的AUC为0.641(95%CI:0.522~0.760,P=0.029)。结论 尼可地尔可减轻老年NSTEMI患者缺血性心肌损伤,改善PCI术后冠状动脉灌注;同型半胱氨酸和D-二聚体是NR/SF独立危险因素。

Objective To investigate the effect of nicorandil on coronary perfusion in elderly patients with acute NSTEMI after PCI.Methods The clinical data of 180 elderly patients with acute NSTEMI who underwent PCI in the Department of Cardiology of the Seventh Medical Center of Chinese PLA General Hospital from June 2020 to February 2022 were collected and analyzed retrospectively.According to whether receiving intravenous injection of nicorandil, the patients were divided into 88 cases in the treatment group and 92 cases in the control group.The peak values and the peak time of serum CK-MB and cTnI,and NT-proBNP were compared between the 2 groups.The coronary perfusion was evaluated by TFG and CTFC,and the results were compared between the 2 groups.The predictive efficiency of no reflow/slow flow(NR/SF) was analyzed by ROC curve.Results The peak value of cTnI, the peak value of CK-MB,the incidence of NR/SF and the number of postoperative CTFC frames were significantly lower, and the peak times of cTnI and CK-MB were obviously shorter in the treatment group than the control group(P<0.05,P<0.01).The elevated homocysteine and D-dimer at admission were the risk factors for NR/SF in NSTEMI patients after PCI(P<0.05).ROC curve analysis indicated that in predicting NR/SF after PCI,the AUC of homocysteine was 0.665(95%CI:0.556-0.775,P=0.010),and AUC of D-dimer was 0.641(95%CI:0.522-0.760,P=0.029).Conclusion Nicorandil can attenuate ischemic myocardial injury in elderly patients with acute NSTEMI and improve coronary perfusion after PCI.Homocysteine and D-dimer are independent risk factors of NR/SF in the patients.