The Effect Of Nicorandil Injection During The Perioperative Period On No-Reflow Slow Blood Flow During Emergency PCI In STEMI Patients And To Observe The Short-Term Prognosis

Objective: To explore the effect of nicorandil injection during the perioperative period on no-reflow/slow blood flow during emergency PCI in STEMI patients and to observe the short-term prognosis.Methods: 107 patients with ST-segment elevation acute myocardial infarction(STEMI)who underwent emergency coronary intervention(PCI)in our hospital from June 2019 to December 2020 were selected as the research objects,and they were divided into 2 groups according to the random number method,52 cases in the control group(nitroglycerin group)and 55 cases in the observation group(nicorandil group).Among the 107 well-grouped patients,the patients whose target blood vessel was diagnosed as the anterior descending artery were also selected,including 26 cases in the nicardil group and 24 cases in the nitroglycerin group.In all control groups,nitroglycerin was injected into the coronary artery after the guide wire or balloon passed through the diseased blood flow during the operation,and thrombus aspiration,nitroglycerin,tirofiban were given according to the experience of the surgeon.The observation group was passed through the guide wire or balloon during the operation After the diseased blood flow appeared,2mg was injected into the coronary artery(injected within 30-60S),and the "nicorandil" was pumped immediately during the operation at 4mg/h to 24 hours after the operation.The immediate myocardial blood perfusion of the two groups of patients was compared,including the corrected TIMI frame number(CTFC),ST segment fall rate,incidence of no-reflow/slow blood flow,heart-related indicators(LVEF,LVEDD,CI,E/A),the occurrence of major adverse cardiovascular events(MACEs).Results: The number of TIMI frames(CTFC)and ST segment fall rate that were corrected immediately after PCI in the observation group were higher than those in the control group,and the incidence of no-reflow/slow blood flow was lower than that of the control group.The difference was significant(P<0.05).Before treatment,there was no significant difference in the cardiac function indexes of the two groups of patients.Immediately after PCI,at 3 and 6 months there was no significant difference in CI,LVEF,E/A,LVEDD in the observation group compared with the control group(P>0.05).Compared with immediately after PCI,the CI,LVEF and E/A of the two groups were significantly increased at 3 and 6 months after surgery(P<0.05),and LVEDD((P>0.05)was significantly reduced.The two groups of patients were significantly reduced after surgery.There was no statistically significant difference between the two groups in the incidence of adverse reactions(headache,decreased liver and kidney function,brady or fast heart rate)in the nicorandril group,while the nicorandril group was better than nitroglycerin in improving the incidence of hypotension(P<0.05).The incidence of adverse cardiac events(cardiogenic death,acute heart failure,unanticipated target vessel reconstruction,stroke,malignant arrhythmia)between the group and the control group was not statistically different(P>0.05).For patients with Left anterior descending branch,there was no significant difference in the cardiac function indexes of the two groups before treatment.Immediately after PCI、3 month and 6 month,the CI,LVEF,and E/A of the observation group were higher than those of the control group(P<0.05),and LVEDD was lower than the control group.Group(P<0.05).Compared with immediately after PCI,CI,LVEF and E/A were significantly increased in the two groups at 3 and 6months after surgery(P<0.05),and LVEDD((P<0.05)was significantly higher.Decrease.The incidence of adverse cardiac events(cardiogenic death,acute heart failure,unanticipated target vessel reconstruction,stroke,malignant arrhythmia)between the group and the control group was not statistically different(P>0.05).Conclusion: Clinically,nicorandil pre-injection is not better than improving cardiac function and reducing adverse cardiac events in patients with ST-segment elevation acute myocardial infarction(STEMI)after PCI Nitroglycerin is significantly better than nitroglycerin in improving cardiac function in patients with anterior descending artery STEMI after PCI.