Objective: To evaluate the effect and safety of Xuesaitong (XST, a Panax Notoginseng extract preparation) via intracoronary injection for treating post-PCI slow-reflow phenomenon in patients with ST-segment elevation myocardial infarction (STEMI) and its impact on patients' prognosis.
Methods: Thirty-nine STEMI patients who suffered from post-PCI slow-reflow after received percutaneous transluminal coronary angioplasty or stenting were assigned to two groups, 20 patients in the treated group and 19 in the control group. Intracoronary administering of 10 mL (0.5 mg) tirofiban and 400 mg XST were given to the treated group through guiding catheter, and followed with 36 h continuous intravenous dripping of tirofiban 10 mL/h and 400 mg XST in 250 mL of saline for dripping, while to the control group, the same intracoronary administering and intravenous dripping of tirofiban but without XST was given. The treatment was implemented for two days. Patients' coronary flow was assessed by the TIMI frame count method (TFC) at 1 min, 5 min and 10 min after injection; and the changes of ST-segment in 2 h, and incidence of bleeding in 48 h after medication were recorded. All patients were followed-up for 6 months to observe the incidence of cardiovascular events.
Results: Before the medication, the TIMI flow grade and the TFC in the treated group and the control group showed insignificantly statistical difference between groups (P > 0.05). After medication, 11 patients (55%) in the treated group and 8 patients (42%) in the control group with their blood flow reaching TIMI grade 3; the TFC decreased at 1, 5 and 10 min to 57.6 +/- 12.6, 46.1 +/- 9.3, 49.8 +/- 10.9 in the treated group and to 69.3 +/- 16.1, 61.2 +/- 15.3, 63.7 +/- 18.3 in the control group; and the 2 h ST segment fallback in them was 1.85 +/- 0.31 mm and 1.40 +/- 0.21 mm respectively, showing that the coronary blood flow in both groups were improved significantly after medication but the improvement in the former was better than in the latter group (P < 0.05). No case of death occurred in the hospitalization period. Results of 6-month follow-up study showed that the incidence of major adverse cardiac events, including angina pectoris, myocardial infarction, heart failure and cardiac death, was 33% in treated group and 44% in the control group, showing insignificant difference between groups (P > 0.05).
Conclusion: Concomitant coronary injection with tirofiban and XST is more effective than that with tirofiban alone in improving the coronary blood flow and shows no increasing on the incidence of hemorrhagic complication.