Effects of intracoronary injection of nicorandil and tirofiban on myocardial perfusion and short-term prognosis in elderly patients with acute ST-segment elevation myocardial infarction after emergency PCI

doi:10.5847/wjem.j.1920-8642.2020.03.005

Abstract

Abstract:

BACKGROUND: This study investigated the effects of the intracoronary injection of nicorandil and tirofiban on myocardial perfusion and short-term prognosis in elderly patients with acute ST-segment elevation myocardial infarction (STEMI) after emergency percutaneous coronary intervention (PCI).

METHODS: Seventy-eight STEMI patients with age >65 years who underwent emergency PCI were consecutively enrolled. These patients received conventional PCI and were randomly divided into a control group and a treatment group (n=39 per group). The control group received an intracoronary injection of tirofiban followed by a maintenance infusion for 36 hours after surgery. The treatment group received intracoronary injection of tirofiban and nicorandil, and then intravenous infusion of tirofiban and nicorandil 36 hours after surgery. The following parameters were measured: TIMI grade, corrected TIMI frame count (cTFC), TIMI myocardial perfusion grade (TMPG), ST-segment resolution (STR) rate 2 hours post-operatively, resolution of ST-segment elevation (STR) at 2 hours postoperatively, peak level of serum CK-MB, left ventricular end diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF) at 7-10 days postoperatively, and major adverse cardiac events (MACEs) in-hospital and within 30 days post-operatively.

RESULTS: Compared with the control group, more patients in the treatment group had TIMI 3 and TMPG 3, and STR after PCI was significantly higher. The treatment group also had significantly lower cTFC, lower infarction relative artery (IRA), lower peak CK-MB, and no reflow ratio after PCI. The treatment group had significantly higher LVEDD and LVEF but lower incidence of MACEs than the control group.

CONCLUSION: The intracoronary injection of nicorandil combined with tirofiban can effectively improve myocardial reperfusion in elderly STEMI patients after emergency PCI and improve short-term prognoses.

Key words: Acute ST-elevation myocardial infarction, Elderly, Emergency coronary intervention, Nicorandil, Tirofiban, Myocardial reperfusion

Guo-xiong Chen, Hong-na Wang, Jin-lin Zou, Xiao-xu Yuan. Effects of intracoronary injection of nicorandil and tirofiban on myocardial perfusion and short-term prognosis in elderly patients with acute ST-segment elevation myocardial infarction after emergency PCI[J]. World Journal of Emergency Medicine, 2020, 11(3): 157-163.

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Parameters	Control (n=39)	Treatment (n=39)	P value
Age (years)	66.2±11.6	67.0±9.7	0.57
Male	35 (89.7)	36 (92.3)	0.49
Smoking	30 (76.9)	29 (74.4)	0.58
Cholesterol (mmol/L)	5.7±1.2	5.6±1.1	0.54
Diabetes	10 (25.6)	12 (30.7)	0.71
Hypertension	19 (48.7)	20 (51.3)	0.29
Coronary artery disease	5 (12.8)	7 (17.9)	0.83
Killip grading
Ⅰ	21 (53.8)	23 (59.0)	0.69
Ⅱ	18 (46.2)	16 (41.0)	0.88
Infarction site
Anterior wall	27 (69.2)	26 (66.7)	0.91
Inferior posterior wall	12 (30.1)	13 (33.3)	0.93
Culprit vessel
Left anterior descending branch	18 (46.2)	19 (48.7)	0.91
Left circumflex branch	9 (23.1)	7 (17.9)	0.69
Right coronary artery	12 (30.1)	13 (33.3)	0.93
Application of thrombus aspiration catheter	3 (7.7)	4 (10.3)	0.28

Groups	n	Post-operative CK-MB peak value (U/L)	STR (%)	MACEs (%)	IRA-no reflow, n (%)
Control	39	259.32±33.54	61.53	33.33	11 (28.21)
Treatment	39	152.12±35.23	89.74	15.38	4 (10.26)
t/χ²	-	0.536	8.73	χ²=1.039	3.93
P value	-	<0.01	<0.05	<0.05	<0.05

Groups	n	Frequent angina pectoris	Cardiac insufficiency	Postoperative hypotension	Acute stent thrombosis	Death	Cardiogenic shock	Total
Control	39	2 (5.13)	3 (7.69)	4 (10.26)	1 (2.56)	2 (5.13)	1 (2.56)	13 (33.33)^*
Treatment	39	1 (2.56)	1 (2.56)	1 (2.56)	1 (2.56)	1 (2.56)	1 (2.56)	6 (15.38)^*

Groups	n	Pre-PCI TIMI grading				Post-PCI TIMI grading
Groups	n	0	1	2	3	0	1	2	3
Control	39	19 (48.7)	9 (23.1)	7 (17.9)	4 (10.3)	1 (2.6)	4 (10.3)	8 (20.5)	26 (64.1)*
Treatment	39	20 (51.3)	7 (17.9)	8 (20.5)	4 (10.3)	0	1 (2.6)	4 (10.3)	34 (87.2)*
χ²	-	0.97	0.95	0.91	0.99	1.25	0.53	5.75	8.79
P	-	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	<0.05

Groups	n	Pre-PCI TMPG grading				Post-PCI TMPG grading
Groups	n	0	1	2	3	0	1	2	3
Control	39	18 (46.2)	9 (23.1)	10 (25.6)	2 (5.1)	1 (2.6)	3 (7.7)	7 (17.9)	28 (71.8)*
Treatment	39	20 (51.3)	9 (23.1)	9 (23.1)	1 (2.6)	0	1 (2.6)	3 (7.7)	35 (89.7)*
χ²	-	0.96	0.99	0.92	0.90	1.25	0.66	6.57	8.96
P	-	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	<0.05