Cardioprotection of anisodamine in patients with right coronary artery acute myocardial infarction during percutaneous coronary intervention / 中华老年医学杂志

ABSTRACT

Objective To investigate the protective efficacy of anisodamine against heart injury after ischemia reperfusion in patients with right coronary artery acute myocardial infarction during percutaneous coronary intervention,and to explore the possible mechanism. Methods Totally 80cases with ST elevation myocardial infarction (STEAMI) were received primary percutaneous coronary intervention (PCI).All patients were randomly divided into 2 groups:anisodamine group (40 cases),5 mg anisodamine was administered when the blood flow recovery after the balloon extension,and control group (40 cases) received saline. The rhythm and rate of heart were observed through the electrocardiogram (ECG) monitor in 30 min after the blood flow recovery.The pressure of aorta were observed through the pressure sensor connected to aorta through catheter.TIMI flow grade (TFG)and corrected TIMI frame count (cTFC) were used to evaluate coronary flow during PCI.Electrocardiography was performed to analysis ST segment resolution 30 min and 24 h after PCI.Venous blood was obtained before and 30 min,1 h,2 h,4 h,24 h and 48 h after PCI to test the levels of superoxide dismutase (SOD),malonyldialdehyde (MDA),creatine kinase isozymes (CKMB) and cardiac troponin I(cTNI) in plasma. Results There were 20 cases(50.0％)of sinus bradycardia,7cases(17.5 ％) of high degree atrioventricular block (AVB),20 cases (50.0 ％ )of frequent ventricular premature,14 cases (35.0％) of paroxysmal supraventricular tachycardia, 5 cases (12.5％) of ventricular fibrillation,19 cases(47.5 ％) of hypotension,3 cases (7.5 ％)of no-reflow phenomenon in anisodamine group which were lower than control group,31 cases (77.5％)of sinus bradycardia,14 cases(35.0％) of high degree AVB,17 cases(72.5％) of paroxysmal supraventricular tachycardia,8 cases (42.5％) of ventricular fibrillation,30 cases (75.0％) of hypotension,6 cases of no-reflow phenomenon (P＜0.05).There were more ST fall＞50％ after rise in anisodamine group than control group after PCI 30 min,but no difference was found after 24 h. The CKMB and cTNI peak value occurred earlier in anisodamine group than control group (P＜0.05).The level of SOD was increased,MDA decreased in anisodamine group compared with control group after PCI 30 min and 24 h (both P＜0.05). Conclusions The use of anisodamine as the blood flow recovery after the balloon extension can reduce no-reflow phenomenon,various of arrhythmia and hypotension during PCI.The underlying mechanism involves the inhibition of oxygen radicals and the improvement of microcirculation.