| Objective: One success criteria for guidelines for acute ST segment elevation myocardial infarction is reaching TIMI flow grade Ⅲ at present.We found that,however,some patients of acute ST segment elevation myocardial infarction undergoing primary percutaneous coronary intervention even reaching the level of TIMI flow grade Ⅲ still experience symptoms such as chest pain relief not completely and ST segment resolution not in time.This situation is considered to be related with microcirculation disturbance.The aim of this study was to investigate whether maximizing microcirculation by adding intracoronary diltiazem continuously to the patients of STEMI up to the standard of TIMI flow grade Ⅲ after PCI could make such patients get maximum benefits for further discussion of TIMI Flow 3 being Enough for the Patients of Acute ST-Segment Elevation Infarction after PCI or not.Methods: The patients conforming the primary percutaneous coronary intervention standard reaching thrombolysis in myocardial infarction grade Ⅲafter PCI and excluding hypotension,severe heart failure,chronic arrhythmia and so on affecting the observations severely were selected as the objects being diagnosed as acute ST-segment elevation myocardial infarction for the first time in the Third Hospital of Hebei medical University from December 2014 to December 2016.These patients were divided into control group(normal saline group,n=37)and experimental group(diltiazem group,n=41)according to the principle of random number table method.Two groups were given corresponding treatment respectively immediately after IRA reaching the TIMI flow grade Ⅲ level.The experimental group was given 8ml diltiazem diluent(125ug/ml)while the others being given 8ml saline immediately with observing the blood pressure,heart rate and other indicators intently.The operators can choose sodium nitroprusside,tirofiban,diltiazem and so on to reach the TIMI flow Ⅲ grade without appearing coronary no reflow.The operative information:TIMI flow grade level after PCI,TMPG(thrombolysis in myocardial infarction)and so on.The postoperative information such as blood pressure and heart rate within 10 min after medication,TMPG,STsegment resolusion within 90 min after PCI,STR≥70% feel good,while STR<70% feel bad,the left ventricular ejecton fraction postoperative 1 week and 3 months,the incidence of major adverse events after Ⅲmonths.Results:1 There is no significant difference between the two groups of the basic Baseline characteristics such as male(62.82%),age,hypertension,diabetes,hyperlipemia,smoking history,blood pressure,heart rate,body mass index,the number of lesion blood vessel,placing stents,the lengh and diameter of stents,TMPG and so on among the total 78 patients.2 The comparision of the TMPG after medication,STR after 90 min,LVEF at one week and 3 months:Compared to the control group,the TMPG blood flow in experimental group was improved(P=0.044<0.05);STR after 90 min in the experimental group(69.17±7.74%)was significantly different from that in the contol group(64.84±8.78%,P=0.023<0.05).The LEVF at one week after PCI has no difference in the two groups(P>0.05);but(55.89±6.00%)the experimental group was increased significantly compared to the control group(61.27±7.42%,P=0.001<0.05).3 The comparison of heart rate,mean arterial pressure after medication within 10 min,postoperative medication and MACEs at 3months:the heart rate has statistical difference between experimental group and control group(70.46±8.96 vs 70.70±9.95 beats per minute,P=0.001<0.05).Postoperative mean arterial pressure has statistical differences between the experimental group and control group(94.29 ±14.96 vs 102.38±14.13 mm Hg,P = 0.035 < 0.05).The postoperative medication has no statistical difference between two groups.All patients were followed up for 3 months,the experimental group had 2 cases suffering from acute heart failure and the control group has 2 the symptoms were improved through related drug therapy.The control group has one recurrence myocardial infarction.the symptoms were improved through PPCI.There is no difference of The MACEs between the two groups(P=0.906>0.05).Conclusions:Intracoronary diltiazem for patients after PCI in treatment of infarction blood flow and myocardial perfusion is beneficial for advancing left ventricular ejection fraction and improving the effect of early prognosis.Continuous intracoronary administration for maximizing the microcirculation in the condition of stable blood pressure and heart rate would be helpful to make the myocardial perfusion as well as cardiac function better without the increase of early major adverse cardiac events.The medicine is security and effective.It can thus be seen that the standard reaching thrombolysis in myocardial infarction flow grade level 3(TIMI Flow 3)is not enough for the patients of acute ST-segment elevation myocardial infarction(STEMI)after PCI and the following treatment of improving microcirculation plays an increasingly important role throughout the whole procedure. |
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