Intracoronary Injection of Nicorandil Alleviates No-Reflow in Elderly Patients with Acute STEMI Undergoing Emergency PCI

Senfeng Liu, Lili Lin, Yuehong Chen, Honglin Dong, Shuyuan Xie, Wei Wang, Yuxuan Huang and Yuanjie Qiu

Background and Objective: The incidence of slow or no reflow during emergency percutaneous coronary intervention (PCI) is as high as 10-30%. How to prevent or alleviate no-reflow and improve myocardial perfusion during PCI has become a crucial clinical issue. To evaluate the impact of intracoronary injection of nicorandil on the no-reflow phenomenon in elderly patients with acute ST-segment Elevation Myocardial Infarction (STEMI) undergoing emergency PCI. Materials and Methods: The clinical data of 200 elderly patients with STEMI exhibiting the no-reflow phenomenon during emergency PCI at The First Affiliated Hospital of Wenzhou Medical University from August, 2016 to December, 2018 were retrospectively analyzed. According to the different treatment methods, they were divided into control group (n = 86) for intracoronary injection of nitroglycerin and study (n = 114) group for intracoronary injection of nicorandil. The two groups were compared in terms of the following indexes: Thrombolysis in Myocardial Infarction (TIMI) flow grade, echocardiographic parameters, serum markers, hemodynamic parameters and major adverse cardiovascular events (MACE). Results: After injection, the study group had higher TIMI flow grade; higher left ventricular ejection fraction, antithrombin III and tissue plasminogen activator; higher E/A ratio; higher cardiac index; lower left atrium volume index, global end-diastolic index and systemic vascular resistance index; lower von Willebrand factor, creatine kinase-MB fraction, cardiac troponin I, N-terminal pro-brain natriuretic peptide, cardiac troponin T and fibrinogen and lower MACE rates than the control group (p<0.05). Conclusion: Intracoronary injection of nicorandil can effectively improve the no-reflow phenomenon and facilitate the prognosis of elderly patients with STEMI undergoing emergency PCI.

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