Effects of Tongxinluo Capsules on myocardial microperfusion in patients free of reflow after PCI and long-term efficacy and safety

doi:10.3969/j.issn.1004-583X.2021.02.007

Abstract

Abstract:

Objective To explore the effects of Tongxinluo Capsules on myocardial microperfusion in patients with percutaneous coronary intervention (PCI) free of reflow and corresponding long-term safety. Methods One hundred and twenty eight patients free of reflow after PCI were randomly divided into two groups by random grouping method, the patients in control group(n=63) received standardized medications, and those in treatment group(n=65) received oral Tongxinluo Capsules based on standardized medications. Baseline clinical conditions, intraoperative surgical operations as well as changes in inflammatory and oxidative stress indicators(hs-CRP, SOD, MDA), cardiac function indicators and myocardial contrast echocardiography images on the 7th day, 30th day and 90th day after surgery, 24 months follow-up of MACE events as well as adverse reactions caused by the use of Tongxinluo Capsules of patients in two groups were compared. Results Highly sensitive C-reactive protein(hs-CRP) and malondialdehyde(MDA) of treatment group at post-operative time node were significantly lower than those of control group, and the differences in two groups till post-operative 30 days were statistically significant, the superoxide dismutase(SOD) of treatment group was higher than those of control group(P<0.05); Myocardial contrast echocardiography was performed on the 30th day, the patients in treatment group were found to have low myocardial perfusion imaging time, high contrast score indexes, and high A·β value when compared to those in the control group, and the difference was even greater on the 90th day(P<0.05); LVEF level of patients in two groups escalated over time, and the level of LVESVI and WMSI decreased over time. The heart function indexes of treatment group were better than those of control group at each time points(P<0.05). The 24-month MACE event rate of treatment group was significantly lower compared to those of control group(P<0.05). No serious adverse drug reactions caused by Tongxinluo capsules were found after 24 months follow-up. Conclusion Early use of Tongxinluo Capsule in patients free of reflow after PCI can reduce inflammation, inhibit oxidative stress, improve myocardial microperfusion and cardiac function, and further enhance patient prognosis, and long-term follow-up shows Tongxinluo Capsule delivers good safety.

Key words: reflow-free phenomenon, tongxinluo capsules, myocardial reperfusion, myocardial contrast echocardiography, oxidative stress

CLC Number:

R542.22

He Na, Li Minxian, Zhang Qi, Xu Fang, Zhang Chenfeng, Song Da. Effects of Tongxinluo Capsules on myocardial microperfusion in patients free of reflow after PCI and long-term efficacy and safety[J]. Clinical Focus, 2021, 36(2): 129-133.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2021.02.007

https://huicui.hebmu.edu.cn/EN/Y2021/V36/I2/129

Figures/Tables 5

References 15

[1]	朱伯谦, 马根山. 支架内再狭窄的治疗进展[J]. 东南大学学报: 医学版, 2011,30(3):525-529.
[2]	王现涛, 李浪. 介入治疗中心肌无复流的研究进展[J]. 中国循环杂志, 2014,29(12):1054-1057.
[3]	杨跃进. 心血管急症救治(12) 经皮冠状动脉介入治疗的风险防范(续完)[J]. 中国循环杂志, 2014,29(10):764-766.
[4]	苏强, 李浪. 经皮冠状动脉介入治疗围手术期心肌损伤的防治进展[J]. 中国循环杂志, 2015,30(12):1231-1234.
[5]	Zhou SS, Tian F, Chen YD, et al. Combination therapy reduces the incidence of no-reflow after primary per-cutaneous coronary intervention in patients with ST-segment elevation acute myocardial infarction[J]. J Geriatr Cardiol, 2015,12(2):135-142.
[6]	Zein AF, Nasution SA, Purnamasari D, et al. The influence of hyperglycemia at admission on in-hospital arrhythmia patients with acute coronary syndrome[J]. Acta Med Indones, 2015,47(4):291-296.
[7]	Terlecki M, Bryniarski L, Bednarek A, et al. The risk of diabetes development in long-term observation of patients with acute hyperglycaemia during myocardial infarction[J]. Kardiologia Polska, 2015,73(8):606-612. doi: 10.5603/KP.a2015.0066 pmid: 26310364
[8]	Morciano G, Giorgi C, Bonora M, et al. Molecular identity of the mitochondrial permeability transition pore and its role in ischemia-reperfusion injury[J]. J Mol Cell Cardiol, 2015,78(8):142-153. doi: 10.1016/j.yjmcc.2014.08.015 URL
[9]	Iwakura K. Stress hyperglycemia and microvascular obstruction after acute myocardial infarction[J]. J Cardiol, 2015,65(4):270-271. doi: 10.1016/j.jjcc.2014.11.012 URL
[10]	Mapanga RF, Essop MF. Damaging effects of hyperglycemia on cardiovascular function: spotlight on glucose metabolic pathways[J]. Am J Physiol Heart Circ Physiol, 2015,310(2):153-173.
[11]	Ito H. Etiology and clinical implications of microvascular dysfunction in patients with acute myocardial infarction[J]. Int Heart J, 2014,55(3):185-189. doi: 10.1536/ihj.14-057 URL
[12]	董丽, 冯启峰, 白雪, 等. 基于“络病-玄府”探讨冠状动脉介入术后无复流现象[J]. 中医杂志, 2016,57(23):2008-2010.
[13]	王永刚, 齐婧. 冠心病中医病因病机的认识与探索[J]. 中医杂志, 2015,56(17):1449-1452.
[14]	李红蓉, 张肖, 常丽萍, 等. 通心络胶囊抗动脉粥样硬化研究进展[J]. 中成药, 2016,38(2):386-391.
[15]	潘嘉西, 章敏学, 郑巨克, 等. 通心络胶囊联合阿托伐他汀与单用阿托伐他汀对冠心病患者血脂、炎症因子水平的影响比较[J]. 2017,15(3):452-453.

项目	治疗组(n=65)	对照组(n=63)	t/χ²值	P值
年龄(岁)	59.28± 15.92	60.58± 16.97	0.447	0.656
男[例(%)]	42(64.61)	40(63.49)	0.018	0.893
高血压[例(%)]	39(60.00)	41(65.08)	0.352	0.553
BMI(kg/m²)	25.66±2.98	26.91±3.13	2.315	0.022
高脂血症[例(%)]	35(53.85)	38(60.32)	0.547	0.460
吸烟[例(%)]	37(56.92)	32(50.79)	0.484	0.487
AMI[例(%)]	48(73.85)	42(66.67)	0.79	0.374
糖尿病[例(%)]	32(49.23)	36(57.14)	0.804	0.370
高尿酸血症[例(%)]	37(56.92)	28(44.44)	1.993	0.158

项目	治疗组(n=65)	对照组(n=63)	t/χ²值	P值
年龄(岁)	59.28± 15.92	60.58± 16.97	0.447	0.656
男[例(%)]	42(64.61)	40(63.49)	0.018	0.893
高血压[例(%)]	39(60.00)	41(65.08)	0.352	0.553
BMI(kg/m²)	25.66±2.98	26.91±3.13	2.315	0.022
高脂血症[例(%)]	35(53.85)	38(60.32)	0.547	0.460
吸烟[例(%)]	37(56.92)	32(50.79)	0.484	0.487
AMI[例(%)]	48(73.85)	42(66.67)	0.79	0.374
糖尿病[例(%)]	32(49.23)	36(57.14)	0.804	0.370
高尿酸血症[例(%)]	37(56.92)	28(44.44)	1.993	0.158

项目	治疗组(n=65)	对照组(n=63)	t/χ²值	P值
急诊PCI[例(%)]	45(69.23)	37(58.73)	1.532	0.216
球囊扩张时间(s)	49.48±17.35	52.71±15.98	1.095	0.276
无复流TIMI分级[例(%)]
0	0(0.00)	0(0.00)
1	18(27.69)	25(39.68)	1.73	0.188
2	47(71.31)	38(61.32)
病变血管数[例(%)]
单支	28(43.08)	18(28.57)
双支	21(32.31)	32(50.79)	4.737	0.094
三支	16(24.61)	13(20.64)
植入支架数[例(%)]
PTCA	10(17.04)	9(14.84)
1个	33(54.07)	23(58.59)	3.483	0.323
2个	18(22.96)	24(17.97)
3个	4(5.93)	7(8.59)
病变血管[例(%)]
LM	6(5.08)	8(6.61)
LAD	68(57.63)	56(46.28)	3.371	0.338
LCX	24(20.34)	28(23.14)
RCA	20(16.95)	29(23.97)
应用IABP[例(%)]	6(9.23)	3(4.76)	0.977	0.323
应用临时起搏器[例(%)]	2(3.08)	4(6.35)	0.767	0.381
血栓抽吸[例(%)]	10(15.38)	14(22.22)	0.982	0.322

项目	治疗组(n=65)	对照组(n=63)	t/χ²值	P值
急诊PCI[例(%)]	45(69.23)	37(58.73)	1.532	0.216
球囊扩张时间(s)	49.48±17.35	52.71±15.98	1.095	0.276
无复流TIMI分级[例(%)]
0	0(0.00)	0(0.00)
1	18(27.69)	25(39.68)	1.73	0.188
2	47(71.31)	38(61.32)
病变血管数[例(%)]
单支	28(43.08)	18(28.57)
双支	21(32.31)	32(50.79)	4.737	0.094
三支	16(24.61)	13(20.64)
植入支架数[例(%)]
PTCA	10(17.04)	9(14.84)
1个	33(54.07)	23(58.59)	3.483	0.323
2个	18(22.96)	24(17.97)
3个	4(5.93)	7(8.59)
病变血管[例(%)]
LM	6(5.08)	8(6.61)
LAD	68(57.63)	56(46.28)	3.371	0.338
LCX	24(20.34)	28(23.14)
RCA	20(16.95)	29(23.97)
应用IABP[例(%)]	6(9.23)	3(4.76)	0.977	0.323
应用临时起搏器[例(%)]	2(3.08)	4(6.35)	0.767	0.381
血栓抽吸[例(%)]	10(15.38)	14(22.22)	0.982	0.322

组别	例数	hs-CRP(mg/L)			MDA(mg/L)			SOD(U/L)
组别	例数	术后7天	术后30天	术后90天	术后7天	术后30天	术后90天	术后7天	术后30天	术后90天
对照组	63	10.93±3.22	8.24±2.72	5.57±1.53	6.38±2.73	5.45±2.26	4.77±1.66	50.1±8.48	71.85±9.64	115.22±11.41
治疗组	65	11.13±2.91	7.73±2.23	4.06±0.93	6.30±3.11	5.01±2.32	4.07±2.02	49.82±9.94	89.51±9.11	132.15±12.13
组间		F=3.58 P<0.05			F=3.22 P<0.05			F=5.26 P<0.01
时点间		F=6.23 P<0.01			F=4.53 P<0.05			F=6.88 P<0.01
组间·时点间		F=27.89 P<0.01			F=22.23 P<0.01			F=32.29 P<0.01