RESUMO
OBJECTIVE： To observe the effects of nicorandil on vascular endothelial function and angina pectoris recurrence in patients with unstable angina pectoris after percutaneous coronary intervention （PCI）. METHODS： Totally 195 patients with unstable angina pectoris were collected from Sichuan Provincial People’s Hospital during Jan. 2016-Mar. 2018， and then divided into control group （97 cases） and observation group （98 cases） according to random number table. Both groups received PCI， and then given basic treatment as Enoxaparin sodium injection， Isosorbide mononitrate sustained-release tablets， Aspirin enteric-coated tablets， Clopidogrel sulfate tablets and Atorvastatin calcium tablets after PCI. Observation group additional received Nicorandil tablet 5 mg， tid， on the basis of control group. Both groups were treated for 6 months. The levels of vascular endothelial function related indexes （FMD， ET-1， NO）， myocardial injury markers （cTnⅠ， CK-MB） and inflammatory factors （hs-CRP） were observed before and after PCI. The recurrent angina pectoris， the occurrence of MACE and ADR were recorded. RESULTS： 6 patients of control group and 4 patients of observation group withdrew from the study. One day before operation， there was no significant difference in the levels of vascular endothelial function， myocardial injury markers or inflammatory factors between 2 groups （P＞0.05）. One day after operation， the levels of FMD and NO in both groups decreased significantly， while the levels of ET-1， cTnⅠ and CK-MB increased significantly （P＜0.05）. The levels of FMD and NO were increased significantly in the 1st and 6th months after surgery， and the observation group was significantly higher than the control group； the levels of ET-1， cTnⅠ， CK-MB and hs-CRP were decreased significantly， and the observation group was significantly lower than the control group （P＜0.05）. The incidence and times of recurrent angina pectoris， duration， the proportion of grade Ⅲ angina pectoris and total incidence of MACE in observation group were significantly lower， less or shorter than control group （P＜0.05）. There was no statistical significance in total incidence of ADR between 2 groups （P＞0.05）. CONCLUSIONS： Additional use of nicorandil can improve vascular endothelial function， relieve the myocardial injury and inflammatory response， reduce the occurrence of recurrent angina pectoris and MACE after PCI and doesn’t influence the safety of routine treatment.
RESUMO
BACKGROUND: Dysfunction of endothelial cells is independently associated with coronary atherosclerotic heart disease. Correlation of dysfunction of endothelial cells to restenosis after stent implantation is not yet clearly determined.OBJECTIVE: To evaluate the correlation of vascular endothelial dysfunction to restenosis after stent implantation. DESIGN, TIME AND SETTING: A case control study was performed at the Department of Cardiology and Department of Heart Ultrasound, Sichuan People's Hospital from March 2005 to January 2007.PARTICIPANTS: After review, coronary angiography showed that 11 patients who occurred restenosis at the lesion region after stent implantation were included in a restenosis group, and an additional 15 patients who did not develop in-stent restenosis were included in a control group. Patients in the following conditions were excluded: over 70 years old, histories of long-term smoking, diabetes mellitus, multivessel disease, long coronary lesion and chronic total occlusion, heart failure (Killip's class Ⅲ or above), severe hepatic and/or renal insufficiency.METHODS: High-resolution ultrasound was used to assess the percentage of flow-mediated dilatation of brachial artery. Differences in endothelial function were compared between both groups.MAIN OUTCOME MEASURES: Ultrasound parameter of the brachial artery in both groups; Partial correlation analysis on control variable including sex, age, blood lipid level, diseased region and stent type.RESULTS: No significant difference was found in basic diameter of brachial artery in both groups. During reactive hyperemia, inner diameter and its absolute variation of brachial artery were smaller in the restenosis group than in the control group (P<0.01). The percentage of brachial artery flow-mediated dilatation was lower in the restenosis group compared with the control group (P=0.013). The partial correlation coefficient between the percentage of flow-mediated dilatation of brachial artery and in-stent restenosis was 0.47 (P=0.04).CONCLUSION: The endothelial dysfunction significantly decreases in patients with restenosis compared with controls following stent implantation. There is a correlation between endothelial dysfunction and restenosis.