Comparative Analysis Of Sodium Nitroprusside And Nicorandil In The Prevention Of Coronary Slow Flow And No Reflow

Background and objective:Direct percutaneous coronary intervention to open infarcted blood vessels is the preferred treatment for revascularization in patients with acute myocardial infarction.However,in a small number of patients,even if the infarct-related artery is opened,angiography shows a decrease or loss of forward blood flow,appears slow blood flow or no reflow.Studies have shown that patients with slow blood flow and no reflow after PCI have a poor prognosis compared with patients with normal blood flow.There is no consistent prevention or treatment strategy for slow blood flow or no reflow.Studies have shown that nicorandil and sodium nitroprusside have a certain improvement effect on patients with slow blood flow.This study compared the preventive effect of slow blood flow and no-reflow about the intracoronary injection of sodium nitroprusside and nicorandil in percutaneous coronary intervention for patients with acute myocardial infarction,clear the preventive effect of the two drugs,and provide reference for clinical prevention strategies.Methods: A total of 240 patients with acute ST-segment elevation myocardial infarction undergoing emergency PCI in The Fifth Affiliated Hospital of Zhengzhou University from April 2015 to April 2018.They were randomly divided into three groups,80 in each group.According to different modes of administration,they were divided into sodium nitroprusside group,nicorandil group and blank control group.Sodium nitroprusside,nicorandil,and physiological saline were administered to the coronary artery in the guide catheter,and then PCI operation was performed.The preoperative and postoperative coronary TIMI grade,intraoperative cornary slow flow and no reflow rate were compared,TIMI flow grade,TIMI myocardial perfusion grade,ST segment fall rate at 2 hours postoperatively,NT-proBNP was detected 1 week after surgery,and LVEF was detected by parallel echocardiography.The incidence of adverse cardiovascular events was measured in the three groups after 30 days.Results:The incidence of cornary slow flow and no-reflow,corrected TIMI frame,CK-MB peak,cTnI peak,and NT-proBNP decreased in the nitroprusside group and nicorandil group compared with the control group.The TIMI blood flow grading,the ratio of reaching TMPG3,the ratio of ST segment fallback ≥50% at 2 hours postoperatively,and the LVEF after operation were higher than those in the control group(P<0.05),and the above indicators in the sodium nitroprusside group were significantly superior than the nicorandil group(P<0.05),the incidence of major adverse cardiovascular events at the 30 th day after operation in the control group and nicorandil group was 18.8% and 15.0%,which were significantly higher than the 3.8% of the sodium nitroprusside group(P <0.05).Conclusion:Pre-injection of sodium nitroprusside and nicorandil into the coronary artery via a guiding catheterhas an effect on the prevention of coronary slow flow and no-reflow in STEMI patients with PCI,and the effect of sodium nitroprusside Better than nicorandil,can significantly reduce the incidence of adverse cardiovascular events 30 days after PCI.The sample size of this study was small and the follow-up time was short.The effects of both on the preventive effect and long-term prognosis of coronary slow flow and no-reflow still need further study.