Effect Of Tirofiban Combined With Nicorandil On Myocardial Microcirculation After Primary Percutaneous Coronary Intervention

OBJECTIVE: The aim of this study was to investigate the effect of tirofiban combined with nicorandil on myocardial microcirculation in patients with ST-segment elevation myocardial infarction(STEMI)after primary percutaneous coronary intervention(PPCI).METHODS: Using retrospective cohort study,we enrolled 101 patients with first-time STEMI undergoing PPCI from September 2017 to March 2019 in 900 Hospital of the Joint Logistics Team.Using the random number table method,patients are divided into tirofiban group(group A,n = 51,15 μg/kg tirofiban was injected into the coronary artery after the guide wire or balloon passed through the lesion),tirofiban and nicorandil group(group B,n = 50,after the guide wire or balloon passed through the lesion,tirofiban 15 μg/kg and nicorandil 6 mg were injected into the coronary artery,and nicorandil 3mg/h was continuously intravenous drip for 24 hours after the operation).The main observation indexes were immediate postoperative myocardial perfusion[Including the corrected TIMI frame count(c TFC)and the incidence of no reflow phenomenon(NRP)],compare two groups of the ST-segment regression(STR)at2 hours after operation,and creatine kinase(CK),CK-MB,brain natriuretic peptide(BNP)at 24 hours after operation.Observe two groups of postoperative 1 week left ventricular ejection fraction(LVEF)and 6 minutes walk test(6MWT)after discharge six months.The secondary observation indexes were major adverse cardiovascular events(MACE)during hospitalization: reperfusion arrhythmia,angina pectoris after infarction,deterioration of cardiac function,malignant arrhythmia,fatal bleeding,nonfatal bleeding,target vessel again reascularization,stroke.In addition,adverse drug reactions [including postoperative headache,postoperative hypotension,and alanine aminotransferase(ALT),total bilirubin(TBIL),serum creatinine(SCr)at 24 hours after operation] were observed between the two groups.RESULTS: The main observation indexes: the c TFC of group A and group B were29.0±9.4 frames and 23.8±7.8 frames respectively,the incidence of NRP were 21.6%and 6.0% respectively,STR at 2 hours after operation were 70.6% and 88.0%respectively,CK-MB at 24 hours after operation were 176(95,300)U/L and130(41,242)U/L respectively,BNP at 24 hours after operation were 449.7(233.0,589.0)and 299.3(176.0,470.9)ug/L respectively,6MWT after discharge six months were404.9±85.4m and 438.2±76.1m respectively,the proportion of walking distance over450 m in 6 minutes is 32% and 52% respectively,the difference between the two groups were statistically significant(P<0.05).There were no significant difference between the two groups in postoperative 24 h CK and postoperative 1 week LVEF(P>0.05).The secondary observation indexes: There were no significant difference between the two groups in MACE during hospitalization(P>0.05).There were no significant difference between the two groups in postoperative headache,postoperative hypotension,and ALT,TBIL,SCr at 24 hours after operation(P>0.05).CONCLUSION: The combination of tirofiban and nicorandil during PPCI can effectively and safely improve myocardial perfusion,reduce the occurrence of NRP,promote ST segment regression,and improve the activity tolerance of STEMI patients.