| ObjectiveThe purpose of this study was to investigate the protective effect of alprostadil on myocardial microcirculation after primary percutaneous coronary intervention(PCI)in patients with ST-segment elevation myocardial infarction(STEMI),and to observe the effect of alprostadil on myocardial perfusion in patients with STEMI after primary PCI.Our findings provide guidance for treatment and understanding of myocardial microcirculation disturbance and myocardial perfusion.Methods200 eligible STEMI patients were selected from the First Affiliated Hospital of Jinzhou Medical University from November 2017 to April 2018.They were randomly divided into alprostadil group(100 cases)and control group(100 cases).The alprostadil group was additionally treated with alprostadil compared to the routine treatment of the control group.The general clinical characteristics,risk factors of coronary heart disease,distribution characteristics of coronary artery lesions,related indicators of PCI and safety evaluation of alprostadil were observed.Comparison of myocardial perfusion index after PCI in both groups,such as grade 3 of thrombolysis in myocardial infarction(TIMI),corrected TIMI frame number(CTFC),grade 3 of myocardial blush grade(MBG),ST segment resolution(?50%)at 2 hours after PCI and no reflow after PCI.The serum levels of tumor necrosis factor-alpha(TNF-alpha),interleukin-6(IL-6),high sensitivity C-reactive protein(hs-CRP),superoxide dismutase(SOD)and malondialdehyde(MDA)were measured and compared on the day of admission and on the 7th day after PCI.After discharge,the two groups of patients were followed up for 3 months.Record the occurrence of major cardiac adverse events(MACE)(including cardiac death,recurrent myocardial infarction,heart failure and target vessel revascularization)and echocardiographic parameters such as left ventricular ejection fraction(LVEF)and left ventricular end diastolic diameter(LVEDD).ResultsIn this study,200 patients were enrolled,including 100 patients in alprostadil group,74 males and 26 females,with an average age of 59.75±8.42;100 patients in control group,66 males and 34 females,with an average age of 58.97±10.89.There were no significant differences in age,sex,risk factors of coronary heart disease,distribution characteristics of coronary artery lesions and basic indexes of PCI between the two groups(P>0.05).The incidence rates of TIMI grade 3,MBG grade 3 and ST segment resolution(?50%)at 2 hours after PCI in alprostadil group were higher than those in control group(P<0.05),and the number of CTFC frames were lower than those in control group(P<0.01).The incidence rate of no-reflow in alprostadil group was lower than that in control group(P=0.046).There were no significant differences in serum levels of TNF-?,IL-6,hs-CRP,SOD and MDA between the two groups at admission(P>0.05);there were significant differences in levels of TNF-a,IL-6,hs-CRP,SOD and MDA on the 7th day after PCI(P<0.01),and the levels of TNF-a,IL-6,hs-CRP and MDA in alprostadil group were lower than those in control group,and the level of SOD was higher than that in control group.There were significant differences in the improvement of TNF-a,IL-6,hs-CRP,SOD and MDA between the two groups(P<0.05),and the improvement of alprostadil group was better than that of control group.There were no significant differences in LVEDD and LVEF between the two groups at 3 days after PCI(P>0.05),but there were significant differences in LVEDD and LVEF at 3 months after discharge(P<0.01),and the LVEDD in alprostadil group was less than that in control group,and the LVEF was larger than that in control group.There were significant differences in the improvement of LVEDD and LVEF between the two groups 3 months after discharge(P<0.01),and the improvement of alprostadil group was better than that of the control group.There were no significant differences in cardiogenic death,recurrent myocardial infarction,target vessel revascularization and heart failure between the two groups within 3 months after discharge(P>0.05),but the overall incidence rate of MACE in alprostadil group was lower than that in control group(P<0.05).In alprostadil group,there were 6 patients with pain and redness at the site of vascular injection.The symptoms were relieved after local cold compress,and the symptoms disappeared after stopping the drug.ConclusionsAlprostadil may improve myocardial microcirculation after primary PCI in patients with STEMI by attenuating inflammatory response and inhibiting oxidative stress,thereby restoring myocardial perfusion.Alprostadil is safe to use and has no obvious adverse effects. |
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