The Effects On No-reflow Of Patients With STEMI Under Nicorandil Or Nitroglycerin Combined With Tirofiban Through PPCI

Objectives:To investigate no-reflow effects of patients with acute ST segment elevation myocardial infarction under nicorandil or nitroglycerin combined with tirofiban through primary percutaneous coronary intervention.Methods : Select 73 patients with acute ST-segment elevation myocardial infarction who were first diagnosed in the First Affiliated Hospital of University of South China and underwent No-reflow phenomenon(NRP)under primary percutaneous coronary intervention from September 2016 to July 2019.According to the no-reflow treatment method,the selected patients were randomly divided into group A(nicorandil combined with tirofiban)and group B(nitroglycerin combined with tirofiban),with 37 patients in group A and 36 patients in group B.In group A,2 mg of nicorandil(diluted in 10 ml normal saline)was injected into the distal end of the target vessel occlusion by puncturing the balloon or microcatheter,and the injection time was about30 seconds.In group B,200?g Nitroglycerin was injected,using the samemethod as group A.And Tirofiban was injected at the first dose of10?g/kg in both group A and group B;the injection was completed in 3-5minutes;followed by continuous intravenous infusion at a dose of0.15?g/kg.min for 24-48 h.By assessing the TIMI blood flow classification of infarct-related arteries,measuring the corrected TIMI frame count(cTFC)of target vessels,recording patients' intraoperative and postoperative hypotension and bleeding during hospitalization,calculating ST-segment resolution,observing postoperative left ventricular ejection fraction(LVEF)at 1 week and recording major adverse cardiovascular events(MACEs)during hospitalization and follow-up 3 months,to observe the effects on no-reflow of patients with STEMI under nicorandil or nitroglycerin combined with tirofiban through primary percutaneous coronary intervention.Results:1.There were no statistically significant differences between the two groups in mean age,sex ratio,prevalence of hypertension,prevalence of diabetes,smoking history,time between the onset and balloon dilation,number of diseased vessels,culprit artery,thrombus aspiration,length of stent,diameter of stent and medication use(p> 0.05).2.The proportion of patients whose TIMI blood flow returned to level 3 in group A was significantly higher than that in group B;cTFC in group A was significantly lower than that in group B.The differenceswere statistically significant(p<0.05).3.The proportion of patients with good ST-segment resolution rate in group A was higher than that in group B,and the difference was statistically significant(p < 0.05);The LVEF 1 week after surgery and the incidence of adverse drug reactions in hospital were not statistically significant in the two groups(p> 0.05).4.There was no significant difference in MACEs between the two groups 3 months after surgery(p>0.05).Conclusion : Tirofiban-nicorandil was more effective than Tirofiban-nitroglycerin in improving no-reflow during PPCI in STEMI patients.