The Impact Of Intracoronary Diltiazem Application Via A Trans-formed Balloon Catheter To Coronary No Reflow Phenomenon During Primary Percutaneous Coronary Intervention For Acute ST Elevation Myocardial Infarction

Objective: To study the impact of intracoronary diltiazem application viaa transformed balloon catheter on coronary no reflow phenomenon (CNRP)during primary percutaneous coronary intervention (PPCI) after predicationfor acute ST elevation myocardial infarction (STEMI).Methods: From July2012to December2013consecutive patients whowere eligible STEMI and received PPCI in cardiovascular department of thethird hospital of Hebei medical university were randomly allocated to testgroup (n=49) and control group (n=51). Operator was chief physician withmore than10years’ experience in interventional cardiology. During the PPCI,instrument was taken upon anatomical structure of every patient. After we gotthe infarction related artery (IRA), we gave the IRA a predication with aballoon. Then, in the test group, the used balloon was cut in longitudinaldirection by a blade and intracoronary2mg diltiazem via the used transformedballoon catheter to the distal vascular bed of target vessel was administered,however, in the control group, intracoronary2mg diltiazem via the guidingcatheter was administered. All of the patients were implanted drug elutingstents. The primary end-points were thrombolysis in myocardial infarction(TIMI) flow grade after drug administered and after the stent implanted andTIMI myocardial perfusion grade (TMPG) after the stent implanted. Thesecondary end-points were the proportion of (>50%) ST-segment resolution2hours after PPCI, the left ventricle ejection fraction (LVEF)1week after PPCI,the major adverse cardiac events (MACEs)3months after PPCI.Results: There were no differences between two groups in baselinecharacteristics (such as age, gender, mean pressure, heart rate, smoking history, family history, previous angina/myocardial infarction/PCI/coronary arterybypass grafting, hypertension,2type diabetes mellitus, dyslipidemia, bodymass index, onset time, door-to-balloon time, the proportion of Killip>2,medications before PPCI), some angiographic characteristics (such as time ofPPCI, expose time, IRA distribution, lesion vessel number, stent diameter,stent length, the maximum dilation pressure, times of dilation, type of guidingwire, type of guiding catheter, initial TIMI, initial TPMG), heart rate afterPPCI, mean pressure after PPCI, MACEs3months after PPCI andmedications before PPCI. The test group was significantly better in the TIMIflow degree (P=0.034) and TPMG (P=0.036) after the stent implanted, theproportion of ST-segment resolution2hours after PPCI (30vs.21, P=0.045),and the LVEF1week after PPCI (52.65±5.36%vs.50.33±4.50%, P=0.021).Conclusion: Drug application to the target vessel via a transformedballoon catheter during PPCI for STEMI can increase perfusion both incoronary and myocardial microcirculation, prevent CNRP and improvecardiac function. While compared with application via a guiding catheter, itdoes not prolong the time of PPCI and expose, also, without significantdifferences in efficiency in blood pressure and heart rate.