JOURNAL ARTICLE
RANDOMIZED CONTROLLED TRIAL

[Effect of urapidil on heart function and ventricular systolic synchrony in acute myocardial infarction patients with no-reflow phenomenon after percutaneous coronary intervention]

Jin-liang Chen, Xiang-hua Fu, Yun-fa Jiang, Wei-ze Fan, Xin-shun Gu, Jin-jun Liu, Wei Geng
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue, Chinese Critical Care Medicine, Zhongguo Weizhongbing Jijiuyixue 2008, 20 (4): 197-9
18419949

OBJECTIVE: To evaluate the influence of intracoronary administration of urapidil on myocardial blush grade (MBG) and left ventricular systolic function and synchrony in the acute myocardial infarction (AMI) patients with no-reflow phenomenon after percutaneous coronary intervention (PCI) identified by MBG.

METHODS: Forty-three patients with AMI, in whom primary PCI was successfully performed (6.25+/-2.37) hours after the onset of angina pectoris,were found to have no-reflow phenomenon. They were randomized into two groups: urapidil group (n=22) and no-reflow control group (n=21). Nitroglycerin (200 microg) was injected into coronary artery. Urapidil (5 mg) was injected into coronary artery after 10 minutes in the urapidil group, and 0.9% NaCl (5 ml, weight percentage) was injected into coronary artery in the no-reflow control group. All the patients received same standard therapy afterwards. The left ventriculography (LVG) was performed immediately and 6 months after PCI to measure the ventricular volume, left ventricular end-diastolic pressure (LVEDP), and wall motion score (WMS). Equilibrium radionuclide angiography (ERNA) was performed 1 week and 6 months after PCI to determine the parameters of left ventricular systolic function and systolic synchrony.

RESULTS: The MBG of urapidil group and control group was grade 0.77+/-0.31 and grade 0.77+/-0.28 after PCI, respectively. The MBG remained unchanged in control group and significantly increased from grade 0.77+/-0.31 to grade 2.37+/-0.27 10 minutes in urapidil group (P<0.05). Follow-up at 6 months after AMI-PCI, left ventricular end-systolic volume index (LVESVI), left ventricular end-diastolic volume index (LVEDVI), WMS and LVEDP were significantly lower in urapidil group compared with those in control group respectively (all P<0.05). The values of left ventricular ejection fraction (LVEF), peak ejection rate (PER), peak filling rate (PFR) of the ERNA as measured by ERNA were significantly increased in urapidil group compared with that in control group (all P<0.05). Phase analysis showed that the left ventricular systolic synchrony parameters phase shift (PS), full width at half maximum (FWHM) and peak phase standard deviation (PSD) were also significantly lower in urapidil group than those in control group (all P<0.05).

CONCLUSION: Intracoronary administration of urapidil can attenuate the no-reflow phenomenon, improve the left ventricular systolic function and synchrony in patients with no-reflow phenomenon after AMI-PCI.

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