Effects Of Intravenous Administration Of Nicorandil On Peri-procedural Myocardial Injury In Patients With Unstable Angina Undergoing Percutaneous Coronary Intervention

Objectives: To investigate the effect of intravenous application of nicorandil on perioperative myocardial injury(PMI)during percutaneous coronary intervention(PCI)in patients with unstable angina(UA)Methods: This study was a prospective,randomized,controlled trial.Patients with unstable angina treated in the fifth cardiovascular departments of the Second Hospital of Hebei Medical University from October 2017 to December 2017 were selected for interventional procedure and had normal baseline cardiac troponin I(cTnI)levels.Patients who met the inclusion criteria were randomly divided into Nicorandil(NCD)group and Nitroglycerin(NIT)group.Patients in the two groups were given conventional drug treatment after admission.Among them,patients in the NCD group received 2 mg/h nicorandil(Beijing Sihuan Kebao)continuous intravenous pump 24 hours before surgery,and the dose was appropriately increased or decreased according to the symptoms.The maximum dose was not more than 6mg/h.Patients in the NIT group were intravenously pumped with nitroglycerin(Beijing Yimin Pharmaceutical)at 10 ?g/min,and adjusted to the maximum tolerable dose according to the patient's clinical symptoms within 6 hours.Under the condition of ensuring hemodynamic stability,maintain the medication for 48 hours.Comparing the general clinical baseline data,intraoperative intervention data,and coronary blood perfusion related parameters between the two groups,blood samples were taken immediately after admission for the detection of serum high-sensitivity C-reactive protein and troponin,while troponin was reexamined 12 hours after PCI and high-sensitivity C-reactive protein was retested 24 hours after PCI.Venous blood was collected to monitor changes in the above indicators.Follow-up comparisons of major adverse cardiac events(MACE)differences within 30 days.SPSS 22.0 statistical software was used for data analysis.P<0.05 was considered statistically significant.Results: During the hospitalization and follow-up period,there were no cardiovascular adverse events such as stroke,recurrent myocardial infarction,and death.There was no statistical difference between the two groups of patients in the general clinical baseline data and intraoperative intervention data.There was no significant difference in cTnI levels measured after admission between the two groups(0.024,0.016-0.030 vs 0.023,0.017-0.028,P=0.670).There was a significant difference in cTnI between groups at different time points(before PCI versus 12 hours after operation)(P < 0.05).Compared with the NIT group,the incidence of PMI in the NCD group was significantly reduced(12.5% vs 46.67%,P=0.03).There was a statistically significant difference in hs-CRP levels between the groups at 24 hours postoperatively(2.17±0.69 vs 2.4 ± 0.77,P = 0.035)There was no significant difference in left ventricular ejection fraction(LVEF)between the two groups before and after 1 week(P> 0.05).Conclusion: Nicorandil can reduce the incidence of PMI in patients with UA after elective PCI.The benefits of nicorandil may be related to reduced levels of inflammatory factors and improved coronary microvascular perfusion.