静脉应用尼可地尔对急性冠脉综合征患者冠脉灌注及临床预后的影响

刘康; 姜子超; 凌维维; 吴丹; 陈韵岱; 钱赓

doi:10.3969/j.issn.2095-5227.2022.01.009

静脉应用尼可地尔对急性冠脉综合征患者冠脉灌注及临床预后的影响

Effect of intravenous nicorandil on coronary perfusion and prognosis in patients with acute coronary syndrome

摘要

摘要:
背景急性冠状动脉综合征(acute coronary syndrome，ACS)患者冠状动脉（以下简称冠脉）介入治疗术后部分可出现慢血流现象，严重影响患者预后，尼可地尔能够改善患者冠脉微循环。
目的探讨ACS患者行经皮冠脉介入治疗(percutaneous coronary intervention，PCI)前静脉应用注射用注射尼可地尔对冠脉灌注及临床预后的影响。
方法连续性入选2017年1月- 2019年12月于解放军总医院就诊的400例择期行PCI的ACS患者，随机分为尼可地尔组与对照组，每组200例，尼可地尔组于术前24 h使用尼可地尔预处理至术后24 h，静脉滴注3 mg/h；对照组同时给予等量的0.9%氯化钠注射液。PCI术中观察支架释放后即刻冠脉血流灌注情况，冠脉灌注情况通过心外膜心肌梗死溶栓治疗试验(thrombosis in myocardial infarction，TIMI)血流(TIMI flow grade，TFG)和校正的TIMI血流帧数计数(corrected TIMI frame count，CTFC)评价。观察两组冠脉灌注指标(TFG和CTFC)和随访期间主要心血管不良事件(major adverse cardiac events，MACE)的差异。
结果最终378例患者临床资料完整，其中尼可地尔组188例，对照组190例，两组临床基线特征和造影数据差异均无统计学意义(P＞0.05)。尼可地尔组与对照组支架释放后TIMI血流≤Ⅱ级的比例(5.9% vs 14.2%，P=0.007)、CTFC值(24.6±6.7 vs 26.3±7.4，P=0.020)、慢血流发生率(8.5% vs 15.8%，P=0.030)差异有统计学意义。随访36个月，尼可地尔组MACE发生率明显低于对照组(3.2% vs 10.5%，P=0.005)。Logistic多因素回归分析提示应用尼可地尔(OR：0.304, 95% CI：0.118 ~ 0.783，P=0.014)是MACE发生的独立预测因素。
结论术前静脉应用尼可地尔可改善ACS患者冠脉微循环灌注，降低远期主要心血管不良事件的发生率。

Abstract:
Background Some patients with acute coronary syndrome (ACS) show slow flow after coronary intervention, which seriously affects the prognosis of patients, while nicorandil can improve the coronary microcirculation.
Objective To investigate the effect of intravenous injection of nicorandil before percutaneous coronary intervention (PCI) on coronary perfusion and prognosis in patients with ACS.
Methods Finally 400 patients with ACS who needed PCI treatment were recruited in the study and randomized to nicorandil group and control group, with 200 cases in each group. The nicorandil group received intravenous infusion 3mg/h of nicorandil in 48 hours, the control group received the same amount of 0.9% sodium chloride injection. During PCI, the coronary perfusion was assessed immediately after the stent released. The coronary perfusion was evaluated by TIMI flow grade (TFG) and the corrected TIMI flow frame count (CTFC). The differences in coronary perfusion indicators (TFG and CTFC) and major adverse cardiac events (MACE) during the follow-up were observed between the two groups.
Results In the end, 378 patients completed our trial, including 188 patients in the nicorandil group and 190 patients in the control group. There was no significant difference in basic clinical characteristics or angiographic data between the two groups (P>0.05). The nicorandil group and the control group showed a statistically significant difference in TIMI ≤ Ⅱ after the stent released (5.9% vs 14.2%, P=0.007). Compared with the control group, the nicorandil group had lower CTFC (24.6±6.7 vs 26.3±7.4, P=0.020) and incidence of slow flow (8.5% vs 15.8%, P=0.030). During 36 months of follow-up, the incidence of MACE in the nicorandil group was significantly lower than that in the control group (3.2% vs 10.5%, P=0.005). Multivariate logistic regression analysis showed that nicorandil (OR: 0.304, 95% CI: 0.118-0.783, P=0.014) was an independent predictor of MACE.
Conclusion Intravenous nicorandil can improve coronary perfusion in ACS patients and show obvious improvement in clinical prognosis.

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