Effect of intracoronary anisodamine and diltiazem administration during primary percutaneous coronary intervention in acute myocardial infarction
Effect of intracoronary anisodamine and diltiazem administration during primary percutaneous coronary intervention in acute myocardial infarction
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DOI：
10.1097/mca.0000000000000167
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发表时间：
2014-12
影响因子：
1.8
通讯作者：
Yuhong Peng;Xianghua Fu;Wei Li;W. Geng;Kun Xing;L. Ru;Jiaan Sun;Yuying Zhao
中科院分区：
文献类型：
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作者：
Yuhong Peng;Xianghua Fu;Wei Li;W. Geng;Kun Xing;L. Ru;Jiaan Sun;Yuying Zhao
本研究的目的是研究在接受直接经皮冠状动脉介入治疗（PCI）的ST段抬高型心肌梗死（STEMI）患者中，支架植入前冠状动脉内给予山莨菪碱和地尔硫卓对即刻血管造影和临床结局的作用。方法择期行PCI的STEMI患者随机分为两组，分别在支架置入前冠状动脉内注射山莨菪碱（1 mg/5 ml）和地尔硫卓（2 mg/5 ml）（COM组，n=54）或生理盐水（5 ml）和地尔硫卓（2 mg/5 ml）（地尔硫卓组，n=54）。主要终点是支架植入后即刻无/缓慢再流[心肌梗死溶栓（TIMI）血流分级≥ 2]的发生率。评估TIMI心肌灌注分级和校正的TIMI帧数。次要终点为主要不良心脏事件，包括死亡、非致死性心肌梗死和靶血管血运重建。结果COM组TIMI血流3级的比例明显高于地尔硫卓组（92.6vs.75.9%，P=0.032）。TIMI心肌灌注3级的比例地尔硫卓组为46.3%，COM组为68.5%，P=0.032。COM组的校正TIMI帧数显著低于地尔硫卓组（P<0.0001）。COM组缓慢性心律失常和快速性心律失常的发生率较低（分别为7.4 vs. 24.1%和3.7 vs. 18.5%，P=0.032，P=0.029）。此外，次要结局指标无显著差异。结论STEMI患者PCI术前冠状动脉内注射山莨菪碱和地尔硫卓可改善冠状动脉造影结果，预防再灌注心律失常。
ObjectiveThe aim of this study was to examine the role of intracoronary anisodamine and diltiazem administration performed before stenting on the immediate angiographic and clinical outcome in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). MethodsSTEMI patients during primary PCI were randomized to two bolus injections of intracoronary anisodamine (1 mg/5 ml) and diltiazem (2 mg/5 ml) (COM group, n=54) or saline (5 ml) and diltiazem (2 mg/5 ml) (diltiazem group, n=54) before stenting. The primary endpoint was the incidence of no/slow reflow [thrombolysis in myocardial infarction (TIMI) flow grade⩽2] immediately after stenting. TIMI myocardial perfusion grade and corrected TIMI frame count were assessed. The secondary endpoints were major adverse cardiac events including death, nonfatal myocardial infarction, and target vessel revascularization. ResultsThe percent of TIMI flow grade 3 was found to be higher in the COM group than in the diltiazem group (92.6 vs. 75.9%, P=0.032). The percent of TIMI myocardial perfusion grade 3 was 46.3% in the diltiazem group and improved in the COM group (68.5%, P=0.032). Corrected TIMI frame count was significantly lower in the COM group than in the diltiazem group (P<0.0001). The COM group showed low incidences of bradyarrhythmia and rapid arrhythmia (7.4 vs. 24.1% and 3.7 vs. 18.5%, respectively, P=0.032, P=0.029). In addition, there were no significant differences in the secondary outcome measures. ConclusionIntracoronary anisodamine and diltiazem administration before stenting improved the angiographic results and prevented reperfusion arrhythmia in patients with STEMI undergoing PCI.