Effects of three intracoronary infusion regimens on myocardial perfusion and short-term prognosis in ST-segment elevation myocardial infarction patients with high thrombus burden after percutaneous coronary intervention
Effects of three intracoronary infusion regimens on myocardial perfusion and short-term prognosis in ST-segment elevation myocardial infarction patients with high thrombus burden after percutaneous coronary intervention
Objective To investigate the effects of three intracoronary infusion regimens on myocardial perfusion and short-term prognosis in patients with acute ST-segment elevation myocardial infarction(STEMI)with high thrombus burden after percutaneous coronary intervention(PCI).Methods Prospective,single-center,randomized controlled study.From March 2017 to August 2021,a total of 150 STEMI patients with high thrombus burden were enrolled in the Department of Cardiology,Jiaozuo People's Hospital.According to the principle of stratified block randomization,they were divided into three groups with 50 cases in each group.Group A:Nicorandil+Tirofiban target vessel perfusion;group B:Prourokinase+Tirofiban target vessel perfusion;group C:Nicorandil+Prourokinase+Tirofiban target vessel perfusion.Thrombolysis in myocardial infarction(TIMI)flow grade,TIMI myocardial perfusion grade(TMPG)and corrected TIMI frame count(CTFC)of infarct-related artery(IRA)were detected and recorded before and immediately after PCI.The ST-segment resolution was recorded before and 24 h after PCI.Curtis-Walker score and the number of malignant arrhythmia cases were recorded within 24 h after IRA opening.Serum high-sensitivity troponin I(hs-cTnI)was detected before PCI and at 0 h,12 h,24 h,3d and 7 d after PCI.Malondialdehyde(MDA)and superoxide dismutase(SOD)were detected before PCI and at 24 h and 7 d after PCI.Left ventricular ejection fraction(LVEF)was measured before PCI and at 7 days,1 month,6 months and 12 months after PCI.Bleeding events during hospitalization and within 30 days after discharge and major adverse cardiovascular events(MACE)within 12 months after PCI were recorded.Results(1)Immediately after PCI,TIMI flow grade and TMPG in group C were better than those in group A(Z=-16.610,P=0.023;Z=-18.400,P=0.015)and group B(Z=-15.130,P=0.046;Z=16.550,P=0.035);The number of CTFC frames in group C was lower than that in group A(P＜0.001)and group B(P=0.001).(2)After PCI,the serum hs-cTnI level in group C was lower than that in group A and group B(both P＜0.001).(3)After PCI,the level of MDA in group C was lower than that in group A and group B(both P＜0.001),and the level of SOD was higher than that in group A(P=0.004)and group B(P=0.024).(4)At 24 h after PCI,the ST-segment resolution in group C was greater than that in group A(P=0.003)and group B(P=0.012),the Curtis-Walker score and the incidence of malignant arrhythmia were lower than those in group A(P=0.008,0.015)and group B(P=0.014,0.034).(5)After PCI,LVEF in group C was greater than that in group A and group B(all P＜0.001).(6)During hospitalization and 30 days after discharge,no major bleeding occurred and the incidence of minor bleeding was similar(x2=1.385,P=0.500)among the three groups;The incidence of MACE in group C was lower than that in group A and group B 12 months after operation(x2=7.400,P=0.025).Conclusions Nicorandil+Prourokinase+Tirofiban target vessel perfusion has a synergistic effect.It may improve myocardial perfusion after PCI,reduce postoperative myocardial injury and oxidative stress injury,promote ST segment resolution,reduce the incidence of malignant arrhythmia,effectively promote the recovery of cardiac function,reduce cardiovascular adverse events in STEMI patients,and do not increase postoperative bleeding.
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