Therapeutic efficacy of intracoronary administration of nicorandil through thrombus aspiration on slow/no-reflow during primary PCI in patients with acute ST-segment elevation myocardial infarction

Abstract:

Objective：To investigate therapeutic efficacy of intracoronary nicorandil injection through thrombus aspiration on slow/no-reflow during primary percutaneous coronary intervention（PCI） in patients with acute ST-segment elevation myocardial infarction （STEMI）. Methods：This was a single-center prospective randomized trial. Consecutive 100 STEMI patients with high thrombus load underwent thrombus aspiration were randomly divided into nicorandil group and control group，followed by administration of nicorandil 4 mg or saline distal to the target lesion via thrombus aspiration. Peak level of creatine kinase isoenzyme（CK-MB），peak time，TIMI blood flow grading，corrected TIMI frame count（cTFC），TIMI myocardial perfusion grading（TMPG），and ST-segment resolution （STR） 90 min after PCI and hemodynamics parameters were recorded. Major adverse cardiovascular events（MACEs） were obtained at 1-month follow-up. Results：The proportion of TMPG3，STR in nicorandil group were statistically higher than those in control group （all P<0.05）. The incidence of slow blood flow/no-reflow（TIMI≤ grade 2），cTFC，peak level of CK-MB，peak time in nicorandil group were significantly lower than those in control group（all P＜0.05）. The incidence of MACEs in nicorandil group was lower than that in the control group（P<0.05）. There was no significant difference in the incidence of symptomatic hypotension and symptomatic brady－cardia between the two groups（P>0.05）. Conclusion：Intracoronary administration of nicorandil through thrombus aspiration catheter in STEMI patients with high thrombus load can better improve myocardial tissue perfusion and reduce the incidence of MACEs，with no significant effect on hemodynamics.