The Effects Of Preventive Intracoronary Administration Of Anisodamine On Myocardial Microcirculation Perfusion After Primary Percutaneous Coronary Intervention In Acute ST-elevation Myocardial Infarction

Objective: To explore the effects of preventive intracoronary administ- ration of anisodamine on myocardial microcirculation perfusion after primary percutaneous coronary intervention in acute ST-elevation myocardial infarction.Methods: From March 2009 to August 2010, a total of ninety five consecutive patients with first-time STEMI who underwent primary PCI within 12 hour of symptom onset were enrolled in this study. Patients were divided into anisodamine group(n=43) and saline control group(n=43) randomizely. IRA was diagnosed by CAG. The lesion of IRA was treated by percutaneous transluminal coronary angioplasty with over the wire balloon. In anisodamine group, 2000ug anisodamine (concentration 100ug/ml) was injected into the coronary artery preventively via over-the-wire-balloon. In control group, equal volume of saline was injected into the coronary artery in the same way. After that the lesion was predilated with the balloon. All patients were implanted drug-eluting stents by the standard of beyond 75% of luminal stenosis measured by QCA. Angiography was done after 5 minutes of stent implanted and CTFC, TMPG were recorded and compared. 200ug nitroglycerin was bolus injected intracoronary before angiography to exclude spasm of coronary artery. Invasive haemodynamic parameters were monitored by PC Scout Monitor 90309(Spacelabs Medical Inc USA) in the course of operation. Myocardial enzymes were dynamicly observed after pPCI within 3 days, and the peak of CK and CK-MB were compared. WMSI(wall motion score index), LVEF(left ventricular ejection fraction, LVEF), LVEDV(left ventricular end diastolic volume), LVESV (left ventricular end systolic volume), CI (cardiac index)were observed and recorded by echocardiography at 1 week and 1months after pPCI in order to assess the effects of preventive intracoronary administration of anisodamine on wall motion and the recovery of ventricular function. Besides, the major adverse cardiac events (MACE) in hospital of the two groups patients, including cardiac deaths, recurrent nonfatal myocardial infarction, severe heart failure, malignant arrhythmias and target vessel revascularization were observed.Results:1 There was no significant difference between the two groups about age, sex, hypertension, hypercholesterolemia, diabetes, smoking, systolic blood pressure, diastolic blood pressure, heart rates and Killlip grade on admission, the incidence of pre-infarction angina and revascularization time (all P value >0.05). There were no significant differences about infracted related artery, multi-vessel lesion and the use of tirofiban between the two groups. In addition, there were no differences in diameters , length and inflation pressure of stents used in primary PCI. TIMI 3 grade were obtained in all patient. No significant differences were found about the oral drugs used after pPCI in the two groups (all P value >0.05) .2 Compared to control group, the proportion of patient with TMPG 3 grade in anisodamine group was much higher (83.72%vs. 62.79%,P<0.05). The CTFC of each coronary artery in anisodamine group is lower than those in control group(LAD: 21.67±7.32 vs. 26.92±8.67; RCA: 21.05±6.17 vs. 24.26±8.51; LCX: 19.75±7.13 vs. 23.59±9.31,all P <0.05). Comparison of whole frame counts within anisodamine group and control group: 0-13 counts were 10cases (23.26%) vs. 5cases (11.63%), 13-23 counts were 29 cases (67.44%) vs. 22cases (51.16%), 23-40 counts were 4 cases (9.30%) vs. 16 cases (37.21%), flow velocity of anisodamine group was obviously quicker than that of control group(P<0.05).3 Within intracoronary administration of anisodamine 5 minutes, systolic, diastolic and mean coronary pressure were not found significant change (P>0.05). The heart rate increased significantly and 2 cases(4.65%) of reperfusion arrhythmia happened in anisodamine group, however, 10 cases (23.26%) happened reperfusion arrhythmia in control group(P<0.05). 4 The peak of CK in anisodamine group and control group were (1336±735)vs.(1705±617)U/L. The peak of CK-MB in anisodamine group and control group were (129±76) vs. (164±68) U/L, differences were significant in statistics (all P<0.05).5 Echocardiography at 1 week after pPCI showed that, compared to control group, LVEF(56.72±7.61 vs. 48.39±8.28%), CI(2.7±1.2 vs. 2.1±0.9 L/min.m2)were higher and LVEDV(123±21.29 vs. 136.23±28.37 ml), LVESV(72.33±17.24 vs. 86.36±16.73 ml), WM(I1.2±0.5 vs. 2.3±1.1) were lower in anisodamine group (all P <0.05). Echocardiography at 1 month after pPCI showed that, compared to control group, LVEF(62.52±9.12 vs. 51.38±7.29%), CI(3.2±1.5 vs. 2.6±1.6 L/min.m2)were higher and LVEDV(114.27±13.28 vs. 122.56±16.72 ml),LVESV(66.25±18.72 vs. 71.29±11.05 ml), WMI(1.7±0.8vs. 0.5±0.18) were lower in anisodamine group (all P <0.05).6 Compared to anisodamine group , the incidence of MACE in the in control group in hospital was more than that in anisodamine group obsviously(11.62% vs. 37.20%, P<0.05). The incidence of severe heart failure was much higher in control group than that in anisodamine group (9.3% vs. 30.23%, P<0.05). The cases of cardiac mortality and malignant arrhythmia in anisodamine group were less than control group, but no significant difference was found (P>0.05). No recurrent nonfatal myocardial infarction and target vessel revascularization happened in the two groups.Conclusion: Preventive intracoronary administration of anisodamine can effectively improve myocardial microcirculation perfusion after primary PCI in acute STEMI,narrow infarction area,prevent ventricular remodeling, decrease the incidence of reperfusion arrhythmia and MACE in hospital. Intracoronary administration of anisodamine is safe and easy for practicing with definite effects and deserved to be widely applied in the clinical practices.