Intracoronary nitroprusside in the prevention of the no-reflow phenomenon in acute myocardial infarction.
- Author:
Wei PAN
1
;
Lan-feng WANG
;
Jia-hui YU
;
Ying FAN
;
Shu-sen YANG
;
Li-jun ZHOU
;
Yue LI
;
Wei-min LI
Author Information
- Publication Type:Journal Article
- MeSH: 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; physiopathology; therapy; Natriuretic Peptide, Brain; blood; Nitroprusside; administration & dosage; Peptide Fragments; blood
- From: Chinese Medical Journal 2009;122(22):2718-2723
- CountryChina
- Language:English
-
Abstract:
BACKGROUNDNo-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.
METHODSNinety-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 angiographic 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.
RESULTSThe 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).
CONCLUSIONIntracoronary nitroprusside can improve myocardial microcirculation, leading to the decrease of the incidence of no-reflow phenomenon and better prognosis.