Objective To evaluate the efficacy and safety of the selective intracoronary injection of diltiazem and sodium nitroprusside on the no-reflow after percutaneous coronary intervention in the patients with acute coronary syndrome (ACS).
Methods 80 patients received PCI treatment with no-reflow phenomenon were enrolled in this study, who were randomly divided into diltiazem group (group A, n = 40) and sodium nitroprusside group (group B, n = 40) from January 2008 to May 2014. Group A of patients: male 25 cases, 15 females, mean age (62.5 ± 13.2) years old. The group A of patients was given diltiazem 200–600 μg with injection from micro-catheter selective coronary to distal target lesions, the group B of patients were given sodium nitroprusside 200–600 μg in the same way from the coronary. We observed coronary Thrombolysis in Myocardial Infarction (TIMI) flow grade and corrected TIMI frame count (CTFC) after administration of 10 min, 20 min respectively, at the same time we observed the plasma levels of high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6) and intercellular adhesion molecule (ICAM-1) as well as the precursor of brain natriuretic peptide (NT-proBNP). The incidence of cardiovascular events was observed after 30d (the primary endpoint including cardiovascular re-angina, re-myocardial infarction, heart failure, ventricular flutter or ventricular fibrillation cardiac death). The difference between the two groups was not statistically gender, age, severity of disease, complications, etc.
Results TIMI flow grade and CTFC showed significant improvement in two groups of patients after treatment. Group A blood flow is restored at the same as group B, the difference was not statistically significant (p > 0.05). Group B, a transient drop in blood pressure, but 3–5 min later back to normal levels; 10–20 min blood pressure returned to normal levels. There was no significant difference between the two groups. In group A the heart rate slow down after diltiazem treatment for 3–10 min, and gradually rebounded after 10–20 min. The heart rate increased in group B after sodium nitroprusside treatment, and gradually rebounded after 10–20 min. There are significant differences in heart rate after 20 min in the two groups (p < 0.05). Compared with before PCI, after one week and 30d of PCI, LVESD, LVEDD were significantly decreased (p < 0.05), LVEF increased significantly (p < 0.05), but the difference was not statistically significant (p > 0.05) in the both groups. In addition, NT-proBNP, hs-CRP, IL-6, ICAM-1 levels were significantly decreased (P < 0.01), but the decreased degree was similar in both groups and not statistically significant (p > 0.05). the numbers of recurrent angina and recurrent acute myocardial infarction as well heart failure were not statistically different (p > 0.05), other cardiovascular event rates (including malignant arrhythmias and sudden death) showed no statistical difference (p > 0.05) between the two groups.
Conclusion Diltiazem and sodium nitroprusside can reduce the no flow phenomenon in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention, no reflow returned to the TIMI3 flow grade level, improved the heart function and decreased the inflammation factors as well as reduce the incidence of cardiovascular events, and their efficacy were quite similar.
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