Efficacy and safety of different drugs by balloon catheter injection for no-reflow following percutaneous coronary intervention / 中华全科医师杂志

ABSTRACT

Objective To evaluate the efficacy and safety of different drugs injected via balloon catheter for no-reflow after percutaneous coronary intervention (PCI) in patients with ST segment elevation myocardial infarction (STEMI).Methods From January 2016 to December 2017,1 280 patients with STEMI were treated in Department of Cardiology,Beijing Luhe Hospital.All patients were underwent PCI and stent implantation in related infarct vessels (IRA).Among 1 280 patients no-reflow occurred in 164 cases (12.81％) during the procedure.No-reflow patients were divided into three study groups according to the order of consultation,who were given verapamil (verapamil group,55 cases),tirofiban (tirofiban group,55 cases) or nitroglycerin (nitroglycerin group,54 cases) by injection through balloon catheter.Coronary blood flow recovery (TIMI grading),myocardial perfusion level TMP grading (TMPG),average dose of drugs (mg) and adverse drug reactions (ADR) were compared among the three groups.Left ventricular ejection fraction (LVEF) and left ventricular end diastolic volume (LVEDV) were evaluated by echocardiography 7 and 30 d after operation.The incidence of major adverse cardiovascular events (MACE) was followed up.Results TIMI-3 ratio in verapamil,tirofiban and nitroglycerin groups was 89.90％ (49/55),91.82％ (45/55) and 61.11％ (33/54),respectively (Hc=13.920,P＜0.05).TMP-3 ratio was 72.73％(40/55) in verapamil group,65.45％ (36/55) in tirofiban group and 50.0％ (27/54) in nitroglycerin group,respectively (Hc=6.230,P＜0.05).During the procedure,one case (1.82％) had slow heart rate and one case (1.82％) had hypotension in verapamil group;three cases 5.56％) had transient hypotension in nitroglycerin group,and there was no significant difference in the incidence of ADR among the three groups (Hc=0.040,P＞0.05).There was no significant difference in LVEF and LVEDV among three groups on the d7 after operation (all P＞0.05).The improvement of LVEF and LVEDV was more significant in verapamil group on d30 after operation (all P＜0.05).One case (1.82％) of heart failure occurred in tirofiban group,three cases of heart failure and one case of recurrent myocardial infarction occurred in nitroglycerin group during six months of follow-up.There was no significant difference in the overall incidence of MACE among the three groups (Hc=0.070,P＞0.05).Conclusion Verapamil can be injected throμgh balloon catheter to restore coronary blood flow rapidly,effectively and safely,and improve left ventricular function in STEMI patients with no-reflux during PCI.