Slow coronary flow phenomenon(SCFP) is an angiographic observation characterized by delayed distal vessel opacifi-cation in the absence of significant epicardial coronary disease. Only limited studies have been focuse...Slow coronary flow phenomenon(SCFP) is an angiographic observation characterized by delayed distal vessel opacifi-cation in the absence of significant epicardial coronary disease. Only limited studies have been focused on the etiologies,clinical manifestations and treatment of this unique angiographic phenomenon. In our case report,we described an 85-year-old man who came with significant ST segment elevation in leads V1-V4 and V3R-V5R without increase in myocardial enzyme. The patient also developed respiratory failure requiring intubation and mechanical ventilation. Coronary angiography revealed only mild atherosclerosis without spasm or thromboembolic occlusion. Slow flow was seen in all coronary arteries,especially in the left anterior descending and right coronary arteries. This case speculated that transmural myocardial ischemia with ST segment elevation might be resulted from slow coronary flow. Transmural myocardial ischemia can occur owing to abnormalities of the coronary microcirculation.展开更多
Objective:To explore the effect of nicorandil on the coronary artery microcirculation and hemodynamics in patients with coronary slow flow (CSF).Methods: A total of 86 patients with CSF who were admitted in our hospit...Objective:To explore the effect of nicorandil on the coronary artery microcirculation and hemodynamics in patients with coronary slow flow (CSF).Methods: A total of 86 patients with CSF who were admitted in our hospital were included in the study and randomized into the treatment group and the control group with 43 cases in each group. The patients in the control group were given aspirin, HMG-CoA reductase inhibitor, and ACEI. On this basis, the patients in the treatment group were given nicorandil. The patients in the two groups were continuously treated for 6 months. The coronary artery microcirculation and hemodynamic indicators before and after treatment in the two groups were detected and compared.Results:TAT, ET-1, and hs-CRP levels, LAD, LCX, RCA, TIMI average blood flow frame count value, and IMR after treatment in the two groups were significantly reduced when compared with before treatment (P<0.05). The above indicators after treatment in the treatment group were significantly lower than those in the control group (P<0.05). FMD after treatment in the two groups was significantly elevated when compared with before treatment (P<0.05). FMD after treatment in the treatment group was significantly higher than that in the control group (P<0.05). Conclusions: Nicorandil in the treatment of CSF can effectively improve the coronary artery microcirculation and hemodynamics, with a significant efficacy.展开更多
BACKGROUND No reflow or slow flow frequently occurs during percutaneous coronary intervention(PCI)and it is associated with adverse outcomes.Strategies should be undertaken to prevent its occurrence.AIM To observe whe...BACKGROUND No reflow or slow flow frequently occurs during percutaneous coronary intervention(PCI)and it is associated with adverse outcomes.Strategies should be undertaken to prevent its occurrence.AIM To observe whether conventional target intracoronary administration of sodium nitroprusside immediately before balloon inflation can reduce the incidence of no reflow and slow flow,which are defined as thrombolysis in myocardial infarction flow grade≤II during PCI.METHODS A retrospective study was conducted in 740 patients with coronary artery disease admitted to Gansu Provincial Hospital of Traditional Chinese Medicine between January 2016 and October 2020.Among them,360 patients receiving sodium nitroprusside immediately before balloon inflation during PCI were enrolled in an experimental group between January 2019 and October 2020 and 380 patients receiving sodium nitroprusside after incident no reflow and slow flow during PCI were enrolled in a control group between January 2016 and January 2019.The occurrence of no reflow and slow flow was compared between the two groups and left ventricular end-diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF)were detected 1 mo after the operation.RESULTS After treatment,the proportion of patients with thrombolysis in myocardial infarction flow grades 0 to II was lower in the experimental group than in the control group(P<0.05).At 1 mo after treatment,LVEDD was lower and LVEF was higher in the experimental group than in the control group(P<0.05).In terms of incidence of adverse cardiovascular events within 1 mo after treatment,in the experimental group,malignant arrhythmia occurred in three patients,intractable myocardial ischemia in three,congestive heart failure in four,and recurrent myocardial infarction in five;one patient died.In the control group,malignant arrhythmia occurred in eight patients,intractable myocardial ischemia in five,congestive heart failure in seven,and recurrent myocardial infarction in 14;two patients died.The incidence of adverse cardiovascular events was 4.4%in experimental group which was lower than that of the control group at 1 mo after operation(9.5%;P<0.05).CONCLUSION Administration of sodium nitroprusside into target vessels immediately before balloon inflation can significantly reduce the incidence of no reflow and slow flow,improve LVEDD and LVEF,and reduce the incidence of adverse cardiovascular events in patients treated by PCI.It is worthy of clinical promotion.展开更多
文摘Slow coronary flow phenomenon(SCFP) is an angiographic observation characterized by delayed distal vessel opacifi-cation in the absence of significant epicardial coronary disease. Only limited studies have been focused on the etiologies,clinical manifestations and treatment of this unique angiographic phenomenon. In our case report,we described an 85-year-old man who came with significant ST segment elevation in leads V1-V4 and V3R-V5R without increase in myocardial enzyme. The patient also developed respiratory failure requiring intubation and mechanical ventilation. Coronary angiography revealed only mild atherosclerosis without spasm or thromboembolic occlusion. Slow flow was seen in all coronary arteries,especially in the left anterior descending and right coronary arteries. This case speculated that transmural myocardial ischemia with ST segment elevation might be resulted from slow coronary flow. Transmural myocardial ischemia can occur owing to abnormalities of the coronary microcirculation.
文摘Objective:To explore the effect of nicorandil on the coronary artery microcirculation and hemodynamics in patients with coronary slow flow (CSF).Methods: A total of 86 patients with CSF who were admitted in our hospital were included in the study and randomized into the treatment group and the control group with 43 cases in each group. The patients in the control group were given aspirin, HMG-CoA reductase inhibitor, and ACEI. On this basis, the patients in the treatment group were given nicorandil. The patients in the two groups were continuously treated for 6 months. The coronary artery microcirculation and hemodynamic indicators before and after treatment in the two groups were detected and compared.Results:TAT, ET-1, and hs-CRP levels, LAD, LCX, RCA, TIMI average blood flow frame count value, and IMR after treatment in the two groups were significantly reduced when compared with before treatment (P<0.05). The above indicators after treatment in the treatment group were significantly lower than those in the control group (P<0.05). FMD after treatment in the two groups was significantly elevated when compared with before treatment (P<0.05). FMD after treatment in the treatment group was significantly higher than that in the control group (P<0.05). Conclusions: Nicorandil in the treatment of CSF can effectively improve the coronary artery microcirculation and hemodynamics, with a significant efficacy.
基金2020 Gansu Planning Projects on Science and Technology,No.20JR10RA352.
文摘BACKGROUND No reflow or slow flow frequently occurs during percutaneous coronary intervention(PCI)and it is associated with adverse outcomes.Strategies should be undertaken to prevent its occurrence.AIM To observe whether conventional target intracoronary administration of sodium nitroprusside immediately before balloon inflation can reduce the incidence of no reflow and slow flow,which are defined as thrombolysis in myocardial infarction flow grade≤II during PCI.METHODS A retrospective study was conducted in 740 patients with coronary artery disease admitted to Gansu Provincial Hospital of Traditional Chinese Medicine between January 2016 and October 2020.Among them,360 patients receiving sodium nitroprusside immediately before balloon inflation during PCI were enrolled in an experimental group between January 2019 and October 2020 and 380 patients receiving sodium nitroprusside after incident no reflow and slow flow during PCI were enrolled in a control group between January 2016 and January 2019.The occurrence of no reflow and slow flow was compared between the two groups and left ventricular end-diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF)were detected 1 mo after the operation.RESULTS After treatment,the proportion of patients with thrombolysis in myocardial infarction flow grades 0 to II was lower in the experimental group than in the control group(P<0.05).At 1 mo after treatment,LVEDD was lower and LVEF was higher in the experimental group than in the control group(P<0.05).In terms of incidence of adverse cardiovascular events within 1 mo after treatment,in the experimental group,malignant arrhythmia occurred in three patients,intractable myocardial ischemia in three,congestive heart failure in four,and recurrent myocardial infarction in five;one patient died.In the control group,malignant arrhythmia occurred in eight patients,intractable myocardial ischemia in five,congestive heart failure in seven,and recurrent myocardial infarction in 14;two patients died.The incidence of adverse cardiovascular events was 4.4%in experimental group which was lower than that of the control group at 1 mo after operation(9.5%;P<0.05).CONCLUSION Administration of sodium nitroprusside into target vessels immediately before balloon inflation can significantly reduce the incidence of no reflow and slow flow,improve LVEDD and LVEF,and reduce the incidence of adverse cardiovascular events in patients treated by PCI.It is worthy of clinical promotion.
