BACKGROUND:This study investigated the effects of the intracoronary injection of nicorandil and tirofiban on myocardial perfusion and short-term prognosis in elderly patients with acute ST-segment elevation myocardial...BACKGROUND:This study investigated the effects of the intracoronary injection of nicorandil and tirofiban on myocardial perfusion and short-term prognosis in elderly patients with acute ST-segment elevation myocardial infarction(STEMI)after emergency percutaneous coronary intervention(PCI).METHODS:Seventy-eight STEMI patients with age>65 years who underwent emergency PCI were consecutively enrolled.These patients received conventional PCI and were randomly divided into a control group and a treatment group(n=39 per group).The control group received an intracoronary injection of tirofiban followed by a maintenance infusion for 36 hours after surgery.The treatment group received intracoronary injection of tirofiban and nicorandil,and then intravenous infusion of tirofiban and nicorandil 36 hours after surgery.The following parameters were measured:TIMI grade,corrected TIMI frame count(c TFC),TIMI myocardial perfusion grade(TMPG),STsegment resolution(STR)rate 2 hours post-operatively,resolution of ST-segment elevation(STR)at 2 hours postoperatively,peak level of serum CK-MB,left ventricular end diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF)at 7–10 days postoperatively,and major adverse cardiac events(MACEs)in-hospital and within 30 days post-operatively.RESULTS:Compared with the control group,more patients in the treatment group had TIMI 3 and TMPG 3,and STR after PCI was significantly higher.The treatment group also had significantly lower c TFC,lower infarction relative artery(IRA),lower peak CK-MB,and no reflow ratio after PCI.The treatment group had significantly higher LVEDD and LVEF but lower incidence of MACEs than the control group.CONCLUSION:The intracoronary injection of nicorandil combined with tirofiban can effectively improve myocardial reperfusion in elderly STEMI patients after emergency PCI and improve shortterm prognoses.展开更多
Background Nicorandil （NIC） is a vasodilatory drug used to treat angina. However, its efficacy of cardioprotection in coronary mi- croembolization （CME） is largely unknown. This study was undertaken to determine w...Background Nicorandil （NIC） is a vasodilatory drug used to treat angina. However, its efficacy of cardioprotection in coronary mi- croembolization （CME） is largely unknown. This study was undertaken to determine whether nicorandil pretreatment could attenuate myo- cardial apoptosis and improve cardiac function after CME in rats. Methods Forty-five rats were randomly divided into a Sham group, a CME group and a CME ＋ NIC （NIC） group （n = 15 per group）. CME was established by injecting plastic microspheres （42 pm in diameter） into the left ventricle of the rats in all of the groups except the Sham group. The NIC group received nicorandil at 3 mg/kg per day for seven days before the operation. Cardiac fimction was assessed by echocardiography, the expression levels of cleaved caspase-9/8/3 were detected by Western blot, microinfarction area was measured by haematoxylin-basic fuchsin picric acid staining, and myocardial apoptosis was de- tected by TUNEL staining. Results Compared to that in the Sham group, cardiac fimction in the CME group was significantly decreased （P 〈 0.05）. However, compared to the CME group, the NIC group showed improved cardiac function （P 〈 0.05）. The expression levels of cleaved caspase-9/8/3 protein and myocardial apoptosis were dramatically increased in the CME group compared to those in the Sham group （P 〈 0.05）, while the NIC pretreatment group had significantly decreased expression levels of cleaved caspase-9/8/3 protein as well as a de- creased apoptotic rate （P 〈 0.05）. Conclusions NIC pretreatment inhibited CME-induced myocardial apoptosis and improved cardiac func- tion through blockade of the mitochondrial and death receptor-mediated apoptotic pathways.展开更多
Previous studies have shown that nicorandil has a protective effect on cardiomyocytes.However,there is no study to investigate whether perioperative intravenous nicorandil can further reduce the myocardial infarct siz...Previous studies have shown that nicorandil has a protective effect on cardiomyocytes.However,there is no study to investigate whether perioperative intravenous nicorandil can further reduce the myocardial infarct size in patients with ST-segment elevation myocardial infarction(STEMI)compared to the current standard of percutaneous coronary intervention(PCI)regimen.The CHANGE(China-Administration of Nicorandil Group)study is a multicenter,prospective,randomized,double-blind and parallel-controlled clinical study of STEMI patients undergoing primary PCI in China,aiming to evaluate the efficacy and safety of intravenous nicorandil in ameliorating the myocardial infarct size in STEMI patients undergoing primary PCI and provide evidence-based support for myocardial protection strategies of STEMI patients.展开更多
目的观察钾通道开放剂尼可地尔对冠心病Warm-up现象及患者反复运动后心率恢复（HRR）的影响。方法选择运动试验阳性以及经冠脉造影证实至少单支冠脉狭窄程度在70%~90%的慢性稳定型心绞痛患者75例。根据干预药物不同分为对照组（常规治...目的观察钾通道开放剂尼可地尔对冠心病Warm-up现象及患者反复运动后心率恢复（HRR）的影响。方法选择运动试验阳性以及经冠脉造影证实至少单支冠脉狭窄程度在70%~90%的慢性稳定型心绞痛患者75例。根据干预药物不同分为对照组（常规治疗）、尼可地尔组（常规治疗＋尼可地尔口服5 mg,3次/d）及单硝酸异山梨酯组（常规治疗＋单硝酸异山梨酯口服20 mg,2次/d）,各25例。各组均服药6个月以上。通过间隔15 min的连续两次运动试验（EX1与EX2）来观察各组缺血阈值（ST段压低0.1 m V时心率血压乘积即RPP值）、出现ST段压低0.1 m V时间（T-STD）、ST段压低的最大值（STDmax）、ST段恢复压低0.05 m V时间、总运动时间（ED）等反映心电图缺血情况的指标以及HRR的变化。结果 3组前后两次运动相比,EX2各指标均较EX1有明显改善（P均〈0.05）;单硝酸异山梨酯组仅STDmax高于对照组（P〈0.05）;尼可地尔组在RPP、T-STD、ST段恢复压低0.05m V时间、STDmax方面均明显优于对照组（P均〈0.01）和单硝酸异山梨酯组（P〈0.05或〈0.01）;尼可地尔组EX1后与EX2后HRR比较,P〈0.01,与对照组比较,P〈0.05。结论尼可地尔可促进冠心病Warm-up现象的发生,钾通道可能作为重要机制参与其中;同时尼可地尔有利于HRR。展开更多
文摘BACKGROUND:This study investigated the effects of the intracoronary injection of nicorandil and tirofiban on myocardial perfusion and short-term prognosis in elderly patients with acute ST-segment elevation myocardial infarction(STEMI)after emergency percutaneous coronary intervention(PCI).METHODS:Seventy-eight STEMI patients with age>65 years who underwent emergency PCI were consecutively enrolled.These patients received conventional PCI and were randomly divided into a control group and a treatment group(n=39 per group).The control group received an intracoronary injection of tirofiban followed by a maintenance infusion for 36 hours after surgery.The treatment group received intracoronary injection of tirofiban and nicorandil,and then intravenous infusion of tirofiban and nicorandil 36 hours after surgery.The following parameters were measured:TIMI grade,corrected TIMI frame count(c TFC),TIMI myocardial perfusion grade(TMPG),STsegment resolution(STR)rate 2 hours post-operatively,resolution of ST-segment elevation(STR)at 2 hours postoperatively,peak level of serum CK-MB,left ventricular end diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF)at 7–10 days postoperatively,and major adverse cardiac events(MACEs)in-hospital and within 30 days post-operatively.RESULTS:Compared with the control group,more patients in the treatment group had TIMI 3 and TMPG 3,and STR after PCI was significantly higher.The treatment group also had significantly lower c TFC,lower infarction relative artery(IRA),lower peak CK-MB,and no reflow ratio after PCI.The treatment group had significantly higher LVEDD and LVEF but lower incidence of MACEs than the control group.CONCLUSION:The intracoronary injection of nicorandil combined with tirofiban can effectively improve myocardial reperfusion in elderly STEMI patients after emergency PCI and improve shortterm prognoses.
基金This work received the support of the National Natural Science Foundation of China （Grant No. 81600283） and the Guangxi Natural Science Foundation （Grant No. 2016 GXNSFBA380022）.
文摘Background Nicorandil （NIC） is a vasodilatory drug used to treat angina. However, its efficacy of cardioprotection in coronary mi- croembolization （CME） is largely unknown. This study was undertaken to determine whether nicorandil pretreatment could attenuate myo- cardial apoptosis and improve cardiac function after CME in rats. Methods Forty-five rats were randomly divided into a Sham group, a CME group and a CME ＋ NIC （NIC） group （n = 15 per group）. CME was established by injecting plastic microspheres （42 pm in diameter） into the left ventricle of the rats in all of the groups except the Sham group. The NIC group received nicorandil at 3 mg/kg per day for seven days before the operation. Cardiac fimction was assessed by echocardiography, the expression levels of cleaved caspase-9/8/3 were detected by Western blot, microinfarction area was measured by haematoxylin-basic fuchsin picric acid staining, and myocardial apoptosis was de- tected by TUNEL staining. Results Compared to that in the Sham group, cardiac fimction in the CME group was significantly decreased （P 〈 0.05）. However, compared to the CME group, the NIC group showed improved cardiac function （P 〈 0.05）. The expression levels of cleaved caspase-9/8/3 protein and myocardial apoptosis were dramatically increased in the CME group compared to those in the Sham group （P 〈 0.05）, while the NIC pretreatment group had significantly decreased expression levels of cleaved caspase-9/8/3 protein as well as a de- creased apoptotic rate （P 〈 0.05）. Conclusions NIC pretreatment inhibited CME-induced myocardial apoptosis and improved cardiac func- tion through blockade of the mitochondrial and death receptor-mediated apoptotic pathways.
基金supported by the National Key Research and Development program of China(2018ZX09201013)Xinxin Merck Cardiovascular Research Fund(2017-CCA-xinxin merck fund-003)。
文摘Previous studies have shown that nicorandil has a protective effect on cardiomyocytes.However,there is no study to investigate whether perioperative intravenous nicorandil can further reduce the myocardial infarct size in patients with ST-segment elevation myocardial infarction(STEMI)compared to the current standard of percutaneous coronary intervention(PCI)regimen.The CHANGE(China-Administration of Nicorandil Group)study is a multicenter,prospective,randomized,double-blind and parallel-controlled clinical study of STEMI patients undergoing primary PCI in China,aiming to evaluate the efficacy and safety of intravenous nicorandil in ameliorating the myocardial infarct size in STEMI patients undergoing primary PCI and provide evidence-based support for myocardial protection strategies of STEMI patients.
文摘目的观察钾通道开放剂尼可地尔对冠心病Warm-up现象及患者反复运动后心率恢复（HRR）的影响。方法选择运动试验阳性以及经冠脉造影证实至少单支冠脉狭窄程度在70%~90%的慢性稳定型心绞痛患者75例。根据干预药物不同分为对照组（常规治疗）、尼可地尔组（常规治疗＋尼可地尔口服5 mg,3次/d）及单硝酸异山梨酯组（常规治疗＋单硝酸异山梨酯口服20 mg,2次/d）,各25例。各组均服药6个月以上。通过间隔15 min的连续两次运动试验（EX1与EX2）来观察各组缺血阈值（ST段压低0.1 m V时心率血压乘积即RPP值）、出现ST段压低0.1 m V时间（T-STD）、ST段压低的最大值（STDmax）、ST段恢复压低0.05 m V时间、总运动时间（ED）等反映心电图缺血情况的指标以及HRR的变化。结果 3组前后两次运动相比,EX2各指标均较EX1有明显改善（P均〈0.05）;单硝酸异山梨酯组仅STDmax高于对照组（P〈0.05）;尼可地尔组在RPP、T-STD、ST段恢复压低0.05m V时间、STDmax方面均明显优于对照组（P均〈0.01）和单硝酸异山梨酯组（P〈0.05或〈0.01）;尼可地尔组EX1后与EX2后HRR比较,P〈0.01,与对照组比较,P〈0.05。结论尼可地尔可促进冠心病Warm-up现象的发生,钾通道可能作为重要机制参与其中;同时尼可地尔有利于HRR。
