Effects Of Different Doses Of DEX On Reperfusion Arrhythmia During PCI In Patients With Acute Anterior Wall Myocardial Infarction

BACKGROUNDAcute anterior wall myocardial infarction(AAMI)is a clinical acute myocardial infarction(anterior wall anoxia or necrosis)caused by obstruction of the left anterior descending branch of the coronary artery.The sudden death rate is high.percutaneous coronary intervention(PCI)is the preferred treatment of AAMI.However,reperfusion arrhythmia(RA)is reported in 50%to 80%of the patient who has PCI.RA refers to acute rhythm disorders such as ventricular premature,ventricular tachycardia and even ventricular fibrillation that occur when the ischemic myocardium restores blood flow.RA can lead to sudden death in patients.Therefore,early prevention and treatment of RA is of great significance for improving PCI safety in patients with acute anterior myocardial infarction.Dexmedetomidine hydrochloride(DEX)is a highly selective α2 adrenergic receptor agonist with sedative,analgesic and anti-sympathetic effects,and is commonly used as an adjunct in clinical anesthesia.Studies have shown that DEX can inhibit oxidative stress and reduce inflammation.RA is related to myocardial oxidative stress and inflammatory response after ischemia myocardium restores blood flow.Animal experiments showed that DEX had antiarrhythmic effects.Whether DEX sedation during PCI reduces the incidence of RA in AAMI patients has not been reported.Therefore,this study aims to investigate the effects of different doses of DEX on the incidence of RA in patients with AAMI during PCI.OBJECTIVEEffect of different doses of DEX on the incidence of RA in patients with AAMI during PCI coronary recanalization.RESEARCH METHODSA total of 150 patients with acute anterior wall myocardial infarction who underwent PCI in the cardiovascular center of our hospital from October 01,2021 to October 01,2022 were selected and divided into three groups by block randomized method:control group(CON group),DEX low-dose group(D1)and DEX high-dose group(D2),with 50 patients in each group.The D1 and D2 groups were given a load dose of DEX 1ug/kg within 10min after entry,and then continued to be pumped with 0.3ug/kg·h and 0.6ug/kg·h,respectively,until the end of the operation,while the CON group was pumped with normal saline as control.Primary outcome:The incidence of arrhythmia within 10min of coronary recanalization during PCI was recorded.Secondary outcome:(1)Serum malondialdehyde(MDA)concentration,hypersensitive C-reactive protein(hs-CRP)concentration and neutrophil(PMN)content were determined by venous blood sampling at admission to the operating room or 10min after coronary artery revascularization.(2)The heart rate(HR)and systolic blood pressure(SBP)of the three groups were recorded at the time of entering the operating room,immediately after the operation,10min after coronary artery recalibration,and at the end of the operation;Finally,the product of SBP and HR(RPP)was calculated to compare myocardial oxygen consumption.(3)Venous blood was extracted at the operating room or at the end of the operation and serum cortisol(COR)level was measured by radioimmunosterone and electronic glucometer was used to determine glucose(GLU)level.(4)Venous blood samples were taken before surgery and at 8h,16h and 24h after surgery to determine the concentrations of serum cardiac troponin I(cTnI)and serum creatine kinase isoenzyme(CK-MB).(5)Patients’ sedation score(Ramsay)was recorded at the time of entering the operating room,10min after coronary artery recanalization,and at the end of surgery.RESULTS(1)Comparison of the incidence of RA within 10min after PCI:The incidence of RA in D1 and D2 groups was significantly lower than that in CON group(P<0.05),D2 group was lower than D1 group(P<0.05).(2)Comparison of myocardial oxidative stress and inflammatory response during PCI:serum hs-CRP,PMN and MDA were not significantly different among the three groups when entering the operating room(P>0.05);The serum concentrations of hs-CRP,PMN,and MDA in CON group were significantly higher than those in D1 and D2 groups at 10 minutes after coronary revascularization,and the serum concentrations in D1 group were higher than those in D2 group(P<0.05).(3)Comparison of myocardial oxygen consumption,stress response and other indicators during PCI:there were no significant differences in HR,SBP and RPP among the three groups at the time of entering the operating room(P>0.05),while HR,SBP and RPP of D1 and D2 groups were significantly lower than those of CON group immediately after the operation,10min after coronary artery recancer,and at the end of the operation(P<0.05).RPP in D2 group was significantly lower than that in D1 group(P<0.05)at 10min after coronary recalculation and the end of surgery.There was no significant difference in the levels of COR and GLU among the three groups when entering the operating room(P>0.05).At the end of operation,both groups D1 and D2 were significantly lower than CON group(P<0.05),and D2 group was significantly lower than D1 group(P<0.05).(4)Comparison of myocardial injury and other indexes during PCI:preoperative serum CK-MB and cTnI levels were not statistically significant between the three groups(P>0.05);The serum concentrations of CK-MB and cTnI in CON group were significantly higher than those in D1 and D2 groups at 8h,16h and 24h after surgery,and D1 group was higher than D2 group(P<0.05).(5)Comparison of Ramsay during PCI:10min after coronary recanalization and at the end of surgery,D1 and D2 groups were significantly higher than CON group(P<0.05).CONCLUSIONS1.In patients with acute anterior myocardial infarction,DEX sedation during PCI can reduce the incidence of RA,which may be related to alleviating myocardial inflammatory response and oxidative stress during coronary recanalization.2.DEX sedation during PCI in patients with acute anterior myocardial infarction can not only effectively inhibit the stress response of the body during perioperative period,but also maintain hemodynamic stability,slow down the heart rate and reduce myocardial oxygen consumption.