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Nicorandil is a new vasodilator, which has the dual effects of nitrate like ester and ATP sensitive potassium channel (KATP channel) opening. Intracoronary injection of nicorandil can expand the coronary artery, protect the coronary microcirculation, and play an anti-inflammatory role, inhibit microthrombosis, increase myocardial perfusion and reduce the incidence of no reflow by acting on a variety of signal pathways; It can also reduce the infarct area and improve cardiac function; Through a variety of cell membrane enzyme signal pathways, it can significantly increase the outflow of potassium ions in cells, cause cell membrane hyperpolarization, inhibit the flow of calcium ions into cells and intracellular calcium overload, reduce the occurrence of abnormal reperfusion rhythm and reperfusion injury. Therefore, it has a good myocardial protective effect on patients with acute myocardial infarction.
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Objective:To investigate the effects of nicorandil combined with thrombus aspiration during percutaneous coronary intervention on reperfusion arrhythmia in patients with acute ST-elevation myocardial infarction.Methods:180 patients with acute ST-elevation myocardial infarction who received treatment in Yidu Central Hospital, Weifang Medical University, China between January 2019 and June 2020 were included in this study. They were randomly assigned to receive either nicorandil combined with thrombus aspiration during percutaneous coronary intervention (NPCI group, n = 90) or conventional PCI (PPCI group, n = 90). Myocardial perfusion (myocardial blush grade 3 blood flow) and the occurrence of reperfusion arrhythmia within 24 hours after treatment were compared between the NPCI and PPCI groups. Results:The incidence of myocardial blush grade 3 blood flow in the NPCI group was significantly higher than that in the PPCI group [84.44% (76/90) vs. 68.88% (62/90), χ2 = 6.01, P = 0.01]. There was no significant difference in the total incidence of reperfusion arrhythmia between NPCI and PPCI groups ( χ2 = 1.19, P = 0.27). The incidence of severe reperfusion arrhythmia in the NPCI group was significantly lower than that in the PPCI group [13.33% (12/90) vs. 27.77% (25/90), χ2 = 5.75, P = 0.02]. The influential factor of severe reperfusion arrhythmia was analyzed by logistic regression taking whether NPCI treatment was used as the variable ( OR = 0.40, 95% CI 0.18-0.89, P = 0.02). The other factors that affect severe reperfusion arrhythmia included age ( OR = 0.71, 95% CI 0.19-0.92, P = 0.04), time from onset to reperfusion of infarct related artery ( OR = 0.62, 95% CI 0.21-0.98, P = 0.02), dcuhistory of pre-infarct angina pectoris ( OR = 0.67, 95% CI 0.19-0.98, P = 0.03), admission blood glucose level ( OR = 1.96, 95% CI 1.05-5.78, P = 0.03), admission leukocyte count ( OR = 1.99, 95% CI 1.02-6.18, P = 0.03) and cardiac function ( OR = 1.71, 95% CI 1.06-6.91, P = 0.04). Conclusion:Nicorandil combined with thrombus aspiration during percutaneous coronary intervention for the treatment of acute ST-elevation myocardial infarction can not only improve myocardial perfusion, but also reduce the incidence of reperfusion arrhythmia. The combined therapy is superior to monotherapy, has certain clinical significance and is innovative.
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Objective:To explore the effect of sequel reperfusion percutaneous coronary intervention (PCI) therapy on heart rate variability (HRV) during myocardial reperfusion in patients with acute ST segment elevation myocardial infarction(STEMI).Methods:With a randomly case controlled study method, 180 patients with STEMI in Yidu Central Hospital Affiliated to Weifang Medical College were selected as study objects, and they were randomly divided into two groups: sequel recanalization PCI(sPCI) group(observation group) and conventional primary PCI(pPCI) group(control group), with 90 cases in each grouop.The rate of SDNN<70 mm of the two groups and other indicators of HRV were observed at 14 d after successful PCI.Results:There was statistically significant difference between the two groups in MBG3(77.78% vs.63.33%, χ 2=4.51, P=0.03). There was statistically significant difference between the two groups in the incidence of SDNN<70 mm at 14 d after PCI(10.00% vs.23.33%, χ 2=5.69, P=0.02). If sequel recanalization PCI was served as a variable for predicting SDNN<70 mm, the results of Logistic regression analysis showed that odds ratio ( OR) value was 0.36, 95% confidence interval ( CI) was 0.16-0.85, P=0.02.The other factors that affected the incidence rate of SDNN<70 mm were the level of MBG3( OR=0.45, 95% CI: 0.16~0.95, P=0.03), time-to-reperfusion( OR=2.65, 95% CI: 1.06~5.98, P=0.04), blood sugar level of admission ( OR=1.96, 95% CI: 1.04~7.71, P=0.04), TnI value( OR=2.06, 95% CI: 1.03~5.68, P=0.04), heart function( OR=2.18, 95% CI: 1.08~6.89, P=0.04). Conclusion:The sequel recanalization PCI may be better than conventional PCI for the patients with STEMI in obtaining myocardial blush grades.Meanwhile, it can increase the indicators of HRV and decrease the incidence rate of SDNN<70 mm.
ABSTRACT
Primary percutaneous coronary intervention is a main treatment for acute myocardial infarction.Although there is vast majority of patients with coronary artery to restore blood flow after percutaneous coronary interventional therapy opened the infarction related artery,no reflow phenomenon is frequently observed and seriously affect the prognosis of patients.The occurrence of no reflow in percutaneous coronary intervention (PCI) is associated with a variety of factors and the pathogenic mechanisms that cause this phenomenon are complex and interrelated.So a better understanding of these mechanisms could judge the possibility of no-reflow and promote the development of individualized prevention and treatment strategies are of great clinical significance for the prevention of no-reflow.
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Objective To explore effects of sequel recanalization PCI therapy(primary coronary intervention,PCI) on cardiac function for the patients with acute ST segment elevation myocardial infarction(STEMI),and related factors.Methods 116 patients with STEMI enrolled were divided randomly into two groups:sequel recanalization PCI group(58 cases) and conventional PCI group(58 cases),and the patients of sequel recanalization PCI group were fully absorbed for thrombus before conventional PCI,then compared estoration of their cardiac function of the patients of two groups at once and 2 weeks after PCI procedure,respectively.Meantime to study the effect related-factors for cardiac function by Logistic regression analysis.Results There were significant differences between two groups in RESVmax(P =0.03) 、RESVmin(P = 0.00) 、REFmax(P = 0.00)、 REDVmax(P = 0.01) and the ratio of E/A(P =0.02)(all P＜0.05);it showed that the restoration of cardiac function of sequel recanalization PCI group was faster than that of conventional PCI group.If sequel recanalization PCI served as a variable for predicting REFmax being 50%,the results of logistic regression showed that OR(odds ratio) value was 3.47,95% CI(confidence interval) 1.39-9.75,P =0.04.Among other variables,as was time-to-recanalization(OR =4.59,P =0.01);infarct size(OR =4.59,P=0.01);Kiliip grades(OR = 3.99,P =0.02)and age(OR=2.75,P=0.04).Conclusion The sequel recanalization PCI could be better than conventional PCI for the patients with STEMI in restoration of heart function,but there should be some other effective factors.
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Objective To study the effects and mechanism of amiodarone on P wave dispersion in preventing paroxgsmal atrial fibrillation.Methods 80 cases with coronary heart disease and paroxysmal atrial fibrillation were randomly dividedl into two groups,study groups were given amiodarone and general treatments of coronary heart disease,control group only with general treatments,to measure the maximal P wave duration(P_(max)),the minimal P wave duration(P_(min)) and P wave dispersion(P_(dis)),before administration and when administration one month,two months and three months,respectivery.Results P_(min) increased,P_(dis) got small after 3 months of adiministration of amiodarone.Compared with control group,the P_(min) of electrocardiographry of study group was obvionsly different(P