Trimetazidine And Nicorandil For Emergency PCI Patients Effects Of Cardiac Function And Short-term Prognosis

Background: Acute myocardial infarction(AMI)is one of the major serious diseases that threaten the life and health of patients,and is one of the most common acute diseases in cardiovascular medicine.The timely,accurate and continuous opening of infarct-related arteries is an important method to reduce the infarct size and improve the prognosis of patients.As one of the important reperfusion methods,emergency PCI(percutaneous coronary intervention)can quickly open the occluded blood vessels and restore the blood perfusion of myocardial cells.However,the cardiac function of some patients after PCI continues to deteriorate.Cell Damage and Coronary Microcirculation Disorders of Cardiomyocytes.Trimetazidine has been widely used in clinic as an anti-angina pill.During acute myocardial hypoxia and ischemia,the aerobic metabolic pathway of normal glucose in the heart has suffered severe damage,which can aggravate the degree of myocardial damage.Trimetazidine is a drug that optimizes myocardial energy metabolism,and clinical evidence currently indicates that Trimetazidine improves outcomes in emergency PCI patients.Nicorandil has a nitrate-like effect and an ATP-sensitive K channel(KATP)opening effect,which can dilate the coronary arteries,especially the dilated coronary microcirculation.The effect of blood / reperfusion injury can improve the clinical prognosis of patients emergency PCI.Objacyive: To investigate whether trimetazidine combined with nicorandil can further improve cardiac function and short-term prognosis of patients emergency PCI.Methods: A prospective,randomized,and controlled study was used.120 patients with AMI who visited our hospital from November 2018 to November 2019 were selected.Randomly divided into 4 groups,nicomandil combined with trimetazidine group,trimetazidine group,nicorandil group,conventional drug group,four groups were treated with direct PCI within 12 hours after onset,combined treatment group On the basis of conventional drug treatment,trimetazidine 20 mg,tid,nicorandil 5mg,tid weretaken orally for 8 weeks.In the trimetazidine group,TMZ 20 mg was added on the basis of conventional medicine treatment,and tid was taken orally for 8 weeks.In the nicorandil group,nicorandil 5mg,tid was administered orally for 8 weeks on the basis of conventional drug treatment,and the conventional drug group was given aspirin,ticagrelor,statin drugs,beta receptor blockers,Optimized treatment of conventional drugs such as ACEI drugs.Collect and record the basic conditions,admission conditions and related intervention data of the four groups of patients.Left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVDD),left ventricular end diastolic diameter(LVDD),and left ventricular end systolic diameter(LVDD)ventricular end systolic diameter(LVDS),BNP levels,and the incidence of cardiovascular events in the four groups of patients recorded over 8 weeks.Results: The preoperative LVEF levels of the combined treatment group,trimetazidine group,nicorandil group and conventional drug group were(44.10 ± 2.95)%,(44.23 ±3.10)%,(44.93 ± 3.77)%,(44.47 ± 3.27)%,No statistical difference between the four groups,the level of(60.04 ± 7.58)% in the combined treatment group after 8 weeks of treatment was higher than the(55.50 ± 10.66)% and(54.10 ± 9.77)% levels in the two single-medication groups,the two single-medication groups Compared with the conventional drug group(49.03 ± 9.17)% level;the four groups of preoperative LVDD levels were(55.67 ± 5.86)mm,(56.73 ± 6.91)mm,(57.70 ± 7.59)mm,(56.23 ± 6.73)mm,the difference Not statistically significant.The preoperative LVDS levels of the four groups were:(41.73 ± 3.62)mm,(42.57 ± 3.66)mm,(44.93 ± 3.77)mm,(44.47 ±3.27)mm,there was no statistical difference between the four groups;the combined medication after 8 weeks The LVDD of the group was(42.27 ± 3.64)mm,which was lower than the(47.53 ± 3.71)mm and(48.43 ± 3.46)mm in the single-medication group.The single-medication group was lower than the conventional drug group(51.70± 3.52)mm.The differences were statistically significant.significance.After 8 weeks,the LVDS level of the combined medication group was(30.40 ± 2.16)mm,which was lower than the(35.90 ± 2.71)mm and(35.40 ± 3.92)mm of the single medication group,and the mm level of the single medication group was lower than that of the conventional medication group(39.33 ± 3.14),The differences are statistically significant(P<0.05).The levels of BNP before treatment in the combined treatment group,trimetazidine group,nicorandil group,and conventional drug group were(377.01 ±99.80)pg / ml,(382.29 ± 150.07)pg / ml,(378.46 ± 148.57)pg / ml,(381.72 ± 151.57)pg / ml had no significant difference;BNP levels in the combined treatment group were(102.71 ± 24.73)pg / ml after 8 weeks of treatment.The levels were(184.38 ± 35.97)pg / ml and(175.29 ± 46.56)pg / ml.The level of the conventional drug group was(207.67 ± 41.05)pg / ml.The level of the single drug group was lower than that of the conventional drug group,and the level of the combined drug group was lower.The level of the medication alone group was low and the difference was statistically significant(P <0.05);the total incidence of MACE in the four groups was 7%,9%,7%,and 8% within 8 weeks.There was no significant statistical difference between the four groups,(P > 0.05).Conclusion: Trimetazidine and nicorandil alone can improve the cardiac function and improve the short-term prognosis of patients with emergency PCI.Trimetazidine combined with nicorandil can further improve the cardiac function and the patient’s cardiac function emergency PCI.The short-term prognosis is worth clinical promotion.