Intracoronary nitroprusside in the prevention of the no-reflow phenomenon in acute myocardial infarction

Background No-reflow phenomenon during percutaneous coronary intervention （PCI） for acute myocardial infarction （AMI） is a predictive factor of continuous myocardial ischemia, ventricular remodeling and cardiac dysfunction, which is closely associated with a worse prognosis. This study aimed to eval...

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Published in:Chinese medical journal 2009-11, Vol.122 (22), p.2718-2723
Main Authors: Pan, Wei, Wang, Lan-feng, Yu, Jia-hui, Fan, Ying, Yang, Shu-sen, Zhou, Li-jun, Li, Yue, Li, Wei-min
Format: Article
Language:English
Subjects:
Acute Disease
Adult
Aged
Angioplasty, Balloon, Coronary - adverse effects
C-Reactive Protein - analysis
Coronary Angiography
Coronary Circulation
Female
Follow-Up Studies
Humans
Male
Middle Aged
Myocardial Infarction - blood
Myocardial Infarction - physiopathology
Myocardial Infarction - therapy
Natriuretic Peptide, Brain - blood
Nitroprusside - administration & dosage
Peptide Fragments - blood
冠状动脉
急性心肌梗死
硝普钠
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Summary:Background No-reflow phenomenon during percutaneous coronary intervention （PCI） for acute myocardial infarction （AMI） is a predictive factor of continuous myocardial ischemia, ventricular remodeling and cardiac dysfunction, which is closely associated with a worse prognosis. This study aimed to evaluate intracoronary nitroprusside in the prevention of the no-reflow phenomenon in AMI. Methods Ninety-two consecutive patients with AMI, who underwent primary PCI within 12 hours of onset, were randomly assigned to 2 groups： intracoronary administration of nitroprusside （group A, n=46）, intracoronary administration of nitroglycerin （group B, n=46）. The angJographic results were observed. The real-time myocardial contrast echocardiography （RT-MCE）, including contrast score index （CSI）, wall motion score index （WMSI）, transmural contrast defect length （CDL） and serious WM abnormal length （WML） were recorded at 24 hours and 1 week post-PCI. High sensitivity C-reactive protein （Hs-CRP） was examined by immune rate nephelometry. N-terminal prohormone brain natriuretic peptide （NT-proBNP） was tested with enzyme-linked immunosorbent assay. Patients were followed up for six months. Major adverse cardiac events （MACE） were recorded. Results The incidence of final TIMI-3 flow in group A was much higher than that in Group B （P 〈0.05）, final corrected TIMI frame count （cTFC） in group A decreased significantly than that in group B （P 〈0.01）. The CSI, CDL/LV length, WMSI and WL/LV length in group A were significantly lower than that in group B （P 〈0.01）. Levels of Hs-CRP and NT-proBNP at 1 week post-PCI decreased significantly in group A than that in group B （P 〈0.01）. Patients were followed up for 6 months and the incidence of MACE in group A was significantly lower than that in group B （P〈0.05）. Conclusion Intracoronary nitroprusside can improve myocardial microcirculation, leading to the decrease of the incidence of no-reflow phenomenon and better prognosis.
ISSN:0366-6999
2542-5641
DOI:10.3760/cma.j.issn.0366-6999.2009.22.008