Comparison of prophylactic effects of intracoronary injection of sodium nitroprusside and nicorandil on slow blood flow and no-reflow

Abstract

Objective \nTo compare the preventive effects of intracoronary injection of sodium nitroprusside and nicorandil on cornary slow flow and no-reflow in patients with acute myocardial infarction undergoing percutaneous coronary intervention. \n \n \nMethods \nA total of 240 patients with acute ST-segment elevation myocardial infarction undergoing emergency PCI in the Fifth Affiliated Hospital of Zhengzhou University from April 2015 to April 2018 were randomly divided into three groups, with 80 cases in each group. According to modes of administration, they were divided into sodium nitroprusside group, nicorandil group and blank control group. The distal end of microcatheter coronary artery lesions were given sodium nitroprusside, nicorandil and normal saline respectively, and then PCI operation was performed. The preoperative and postoperative coronary TIMI grade, intraoperative cornary slow flow and no-reflow rate, TIMI flow grade, TIMI myocardial perfusion grade, ST segment fall rate at 2 hours postoperatively were compared; NT-proBNP was detected at 1 week after surgery, and LVEF was detected by parallel echocardiography. The incidence of adverse cardiovascular events was measured in the three groups 30 days after treatment. \n \n \nResults \nThe incidences of cornary slow flow and no-reflow, corrected TIMI frame, CK-MB peak, cTnI peak, and NT-proBNP were lower in the sodium nitroprusside group and nicorandil group than those in the control group(P<0.05). The TIMI blood flow grading, the ratio of reaching TMPG3, the ratio of ST segment fallback ≥50% at 2 hours postoperatively, and the LVEF after operation were higher than those in the control group (P<0.05), and the above indicators in the sodium nitroprusside group were significantly higher than those of the nicorandil group (P<0.05). The incidence of major adverse cardiovascular events 30 days after operation in the control group and nicorandil group was 18.8% and 15.0%, which was significantly higher than that (3.8%) of the sodium nitroprusside group (P<0.05). \n \n \nConclusions \nIntracoronary injection of sodium nitroprusside and nicorandil can effectively prevent cornary slow flow and no reflow in patients with acute myocardial infarction, but the sodium nitroprusside is more effective and can significantly reduce the incidence of adverse cardiovascular events 30 days after operation. \n \n \nKey words: \nAcute myocardial infarction;\xa0Percutaneous coronary intervention;\xa0Cornary slow flow;\xa0No-reflow