Influences of intracoronary application of tirofiban or nicorandil on clinical effect in patients with acute ST-segment elevation myocardial infarction after percutaneous coronary intervention / 中国医师进修杂志

ABSTRACT

Objective:To explore the effects of intracoronary application of tirofiban or nicorandil in patients with acute ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI).Methods:A total of 198 STEMI patients who were admitted to Hefei High-Tech Cardiovascular Hospital during the period from January 2017 to January 2020 were enrolled. They were divided into tirofiban group, nicorandil group and control group by random number table method, with 66 cases in each group. Patients in the tirofiban group, nicorandil group and control group were given tirofiban, nicorandil and 0.9% sodium chloride in coronary artery before PCI, respectively. After surgery, the three groups were given routine drugs. TIMI blood flow grade and TIMI myocardial perfusion grade (TMPG) before and after surgery in the three groups were recorded. The corrected TIMI frame count (cTFC), TIMI myocardial perfusion frame count (TMPFC), peak levels of serum creatine kinase (CK) and creatine kinase isoenzymes (CK-MB) after surgery in the three groups were statistically analyzed. The reperfusion arrhythmias in PCI, severe hypotension and perioperative bleeding, and number of cases with major adverse cardiac events (MACE) within 3 months after surgery in the three groups were recorded.Results:After surgery, number of cases with TIMI blood flow grading at grade 0- 3 in tirofiban group, nicorandil group and control group was (0, 2, 4, 60) cases, (0, 1, 4, 61) cases and (1, 4, 9, 52) cases, respectively. The number of cases with TMPG grading at grade 0- 3 in tirofiban group, nicorandil group and control group was (0, 3, 6, 57)cases, (0, 2, 5, 59) cases and (1, 5, 11, 49) cases, respectively. TIMI blood flow grading and TMPG in tirofiban group and nicorandil group were significantly better than those in control group ( P<0.05), and there was no significant difference between tirofiban group and nicorandil group ( P>0.05). The cTFC, TMPFC, peak level of CK, peak level of CK-MB, incidence of reperfusion arrhythmia and incidence of MACE in tirofiban group, nicorandil group and control group were [(25.32 ± 5.11) frames, (93.84 ± 13.46) frames, (1 095.32 ± 306.36) U/L, (191.81 ± 63.31) U/L, 19.70%, 18.18%], [(25.17 ± 5.38) frame, (94.74 ± 13.17) frame, (1 113.19 ± 385.68) U/L, (189.72 ± 62.22) U/L, 18.18%, 21.21%] and [(29.85 ± 7.63) frames, (101.38 ± 18.52) frames, (1 669.81 ± 537.61) U/L, (341.68 ± 108.57) U/L, 36.36%, 39.39%], respectively. The above indexes in tirofiban group and nicorandil group were significantly lower than those in control group ( P<0.05), and there was no significant difference between tirofiban group and nicorandil group ( P>0.05). Conclusions:Preoperative intracoronary application of tirofiban or nicorandil is conducive to improving myocardial function and micro-circulation disorders in STEMI patients after PCI, which is of positive roles on improving the short-term prognosis of cardiac function.