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

Abstract

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 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.

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.

• Authors: Wei Pan, Lan-feng Wang, Jia-hui Yu, Ying Fan, Shu-sen Yang, Li-jun Zhou, Yue Li, Wei-min Li
• Journal: Chinese medical journal (Chin Med J (Engl)) Vol. 122 Issue 22 Pg. 2718-23 (Nov 20 2009) ISSN: 2542-5641 [Electronic] China
• PMID: 19951602 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Peptide Fragments
• pro-brain natriuretic peptide (1-76)
• Natriuretic Peptide, Brain
• Nitroprusside
• C-Reactive Protein

Topics

• 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)