Effect of Intravenous Administration of Liposomal Prostaglandin E1 on Microcirculation in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Intervention

Abstract

Background:Several studies have demonstrated that primary percutaneous coronary intervention (PCI) can result in reperfusion injury. This study aims to investigate the effectiveness of liposomal prostaglandin E1 (Lipo-PGE1, Alprostadil, Beijing Tide Pharmaceutical Co., Ltd.) for enhancing microcirculation in reperfusion injury. In addition, this study determined the optimal administration method for acute ST elevation myocardial infarction (STEMI) patients undergoing primary PCI.Methods:Totally, 68 patients with STEMI were randomly assigned to two groups: intravenous administration of Lipo-PGE1 (Group A), and no Lipo-PGE1 administration (Group B). The corrected thrombolysis in myocardial infarction (TIMI) frame count (cTFC) and myocardial blush grade (MBG) were calculated. Patients were followed up for 6 months. Major adverse cardiac events (MACE) were also measured.Results:There was no significant difference in the baseline characteristics between the two groups. The cTFC parameter in Group A was significantly lower than Group B (18.06 ± 2.06 vs. 25.31 ± 2.59, P < 0.01). The ratio of final MBG grade-3 was significantly higher (P < 0.05) in Group A (87.9%) relative to Group B (65.7%). There was no significant difference between the two groups in final TIMI-3 flow and no-reflow. Patients were followed up for 6 months, and the occurrence of MACE in Group A was significantly lower than that in Group B (6.1% vs. 25.9% respectively, P < 0.05).Conclusions:Myocardial microcirculation of reperfusion injury in patients with STEMI, after primary PCI, can be improved by administering Lipo-PGE1.

Alprostadil attenuates LPS-induced cardiomyocyte injury by inhibiting the Wnt5a/JNK/NF-κB pathway

“…[24][25][26][27]. Furthermore, PGE1 improved the myocardial microcirculation and alleviated apoptosis of myocardial cells [28,29]. These findings indicate that alprostadil may have an anti-inflammatory effect, although its molecular mechanisms are not exactly clear.…”

Effects of prostaglandin E1 on reperfusion injury patients

“…Of the 6 included studies, 3 involved patients receiving elective PCI, [ 25 – 27 ] 1 involved primary PCI, [ 28 ] 1 involved elective mitral valve surgery, [ 29 ] and 1 involved elective CABG or valve surgery [ 30 ] (Table 1 ).…”

“…In 2 other studies, [ 25 , 26 ] patients were administered 20 μg/day PGE1 starting at least 48 hours before PCI and continuing for 5 days or starting 3 days before PCI and continuing for 4 days after PCI, respectively. Moreover, one [ 28 ] study described the administration of 20 μg PGE1 immediately after coronary angiography and another [ 27 ] administered 0.005 to 0.03 μg/kg/min PGE1, starting at least 2 hours before PCI and continuing for 24 hours.…”

Alprostadil Injection Attenuates Coronary Microembolization-Induced Myocardial Injury Through GSK-3β/Nrf2/HO-1 Signaling-Mediated Apoptosis Inhibition

“…Previous studies have found that intravenous administration of alprostadil in patients with ST elevation myocardial infarction undergoing primary PCI could improve myocardial microcirculation, reduce myocardium non-flow area, and decrease major adverse cardiac events (MACE). 32 Interestingly, alprostadil injection also provides cardioprotection effects on elective PCI patients with unstable angina, which reduces the incidence rates of periprocedural myocardial injury, and decreases pro-inflammatory factor secretion. 33 In human chronic ischemia heart disease, alprostadil effectively stimulates neoangiogenesis in infarct areas adjacent to the viable myocardium.…”