在急性心肌梗死患者经皮冠状动脉介入治疗中，球囊扩张前选择性冠状动脉内给予硝普钠可预防慢血流现象。

Selective intracoronary administration of nitroprusside before balloon dilatation prevents slow reflow during percutaneous coronary intervention in patients with acute myocardial infarction.

作者信息

Shinozaki Norihiko, Ichinose Hiroyuki, Yahikozawa Kumiko, Shimada Hirohide, Hoshino Kazuo

机构信息

Department of Cardiology, Naganoken Koseiren Shinonoi General Hospital, Nagano, Japan.

出版信息

Int Heart J. 2007 Jul;48(4):423-33. doi: 10.1536/ihj.48.423.

DOI:10.1536/ihj.48.423

PMID:17827814

Abstract

BACKGROUND

Previous studies have shown that intracoronary nitroprusside injection is safe and effective after slow reflow complicates percutaneous coronary intervention (PCI).

OBJECTIVES

We sought to determine the safety and efficacy of selective intracoronary administration of nitroprusside through the drug delivery catheter before balloon dilatation to prevent no or slow reflow during PCI for acute myocardial infarction (AMI).

METHODS

We studied 120 consecutive patients with AMI treated by PCI. In 60 patients (nitroprusside group), nitroprusside (120 mug) was selectively administered through the drug delivery catheter into the distal coronary artery to reach the target lesion before balloon dilatation. Clinical and angiographic data, as well as in-hospital outcomes, of the nitroprusside group were retrospectively compared with 60 patients who had conventional PCI without nitroprusside (control group).

RESULTS

There were no significant differences in the baseline clinical and angiographic characteristics between the 2 groups. Compared to the control group, the nitroprusside group had 1) less slow reflow during the procedure (12% versus 35%, P = 0.0025), 2) a shorter fluoroscopic time (14.4 +/- 7.9 versus 18.7 +/- 9.1 minutes, P = 0.0093), 3) a shorter procedure time (57.6 +/- 20.6 versus 78.1 +/- 26.4, P < minutes, P < 0.0001), 4) a better final TIMI flow grade (III:II:I:0 = 59:1:0:0 versus 53:6:1:0, P = 0.0284), 5) a better blush grade (III:II:I:0 = 49:10:1:0 versus 33:15:8:4, P = 0.0006), and 6) a better corrected TIMI coronary flame count (30.8 +/- 13.7 versus 46.5 +/- 44.7, P = 0.0102). There were no particular complications with nitroprusside use.

CONCLUSIONS

The selective intracoronary administration of nitroprusside prior to PCI is safe and well tolerated, prevents no or slow reflows, and improves reperfusion of the infarcted myocardium.

摘要

背景

既往研究表明，在经皮冠状动脉介入治疗（PCI）出现慢血流并发症后，冠状动脉内注射硝普钠是安全有效的。

目的

我们旨在确定在球囊扩张前通过给药导管选择性冠状动脉内给予硝普钠以预防急性心肌梗死（AMI）患者PCI过程中无复流或慢复流的安全性和有效性。

方法

我们研究了120例连续接受PCI治疗的AMI患者。60例患者（硝普钠组）在球囊扩张前通过给药导管将硝普钠（120μg）选择性注入冠状动脉远端以到达靶病变。将硝普钠组的临床和血管造影数据以及院内结局与60例接受无硝普钠的传统PCI患者（对照组）进行回顾性比较。

结果

两组之间的基线临床和血管造影特征无显著差异。与对照组相比，硝普钠组有：1）术中慢血流较少（12% 对35%，P = 0.0025）；2）透视时间较短（14.4±7.9对18.7±9.1分钟，P = 0.0093）；3）手术时间较短（57.6±20.6对78.1±26.4分钟，P < 0.0001）；4）最终TIMI血流分级更好（Ⅲ:Ⅱ:Ⅰ:0 = 59:1:0:0对53:6:1:0，P = 0.0284）；5）心肌 blush分级更好（Ⅲ:Ⅱ:Ⅰ:0 = 49:10:1:0对33:15:8:4，P = 0.0006）；6）校正的TIMI冠状动脉血流帧数更好（30.8±13.7对46.5±" />