Intracoronary nitroprusside for the prevention of the no-reflow phenomenon after primary percutaneous coronary intervention in acute myocardial infarction. A randomized, double-blind, placebo-controlled clinical trial

Amit, Guy; Cafri, Carlos; Yaroslavtsev, Sergei; Fuchs, Shmuel; Paltiel, Ora; Abu‐Ful, Akram; Weinstein, Jean Marc; Wolak, Arik; Ilia, Reuben; Zahger, Doron

doi:10.1016/j.ahj.2006.05.010

Cited by 106 publications

(73 citation statements)

References 22 publications

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“…63 A recent double-blind clinical trial showed that the intracoronary administration of nitroprusside (60 g) selectively injected into the infarct-related artery distal to the occlusion improved clinical outcomes at the 6-month follow-up in AMI patients treated with primary PCI but did not improve myocardial tissue reperfusion. 49 Further study is needed to assess the effects of nitric oxide donors in the prevention of reperfusion injury and LV remodeling and improved clinical outcomes.…”

Section: Nitric Oxidementioning

confidence: 99%

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Pharmacological Intervention for Prevention of Left Ventricular Remodeling and Improving Prognosis in Myocardial Infarction

et al. 2008

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Early reperfusion of totally occluded coronary arteries with thrombolysis and/or percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) reduces infarct size, cardiac mortality, and in-hospital events. 1,2 Prompt reperfusion of epicardial blood flow reduces infarct size and mortality rates, in-hospital events, and reinfarction. Furthermore, successful reperfusion greatly affects the reduction in infarct size and left ventricular (LV) function. The reduction in infarct size and the improvement in LV ejection fraction may decrease mechanical stress on the noninfarcted myocardium, preventing LV remodeling, including changes in LV size and shape. 3 Preventing LV remodeling is of key importance after AMI because it may be related to a reduction in adverse cardiac events, including exacerbation of congestive heart failure and cardiac mortality rates. 4 -7 Although reperfusion therapy relieves and reduces ischemia and necrosis, the process of restoring coronary blood flow causes ischemiareperfusion injury in the ischemic myocardium, which limits the beneficial effects of reperfusion and may contribute to mortality despite successful reperfusion therapy. 8,9 Reperfusion injury is triggered by cellular and mitochondrial calcium overload, oxidant stress, endothelial dysfunction, reduction in nitric oxide production, and other factors. Because reperfusion injury limits the efficacy of reperfusion therapy alone, combined use with pharmacological intervention may moderate microcirculatory impairment and clinical outcomes. Such treatments may eventually reduce infarction size and prevent ischemic LV remodeling after AMI. Furthermore, medication in the chronic phase may affect LV remodeling and clinical prognoses. We undertook a systematic review of the literature based on pharmacological reductions in infarct size and prevention of LV remodeling, both of which may be associated with improved clinical outcomes, in cases of MI. In this review, searches through MEDLINE, LILACS, and SCIELO were the sources of information. Articles were selected by their content related to the theme.

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Section: Nitric Oxidementioning

confidence: 99%

“…The translation of these effects into the clinical setting has been attempted ( Table 2). [42][43][44][45][46][47][48][49][50][51][52] How does the pharmacological preconditioning effect occur after the vessel is occluded? There are facets to this question.…”

Section: Pharmacological Therapy Combined With Reperfusionmentioning

confidence: 99%

Pharmacological Intervention for Prevention of Left Ventricular Remodeling and Improving Prognosis in Myocardial Infarction

et al. 2008

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“…33,34 However, in a randomized trial for the prevention of no-reflow after PPCI in 98 patients presenting with STEMI, in which intracoronary nitroprusside was given beyond the occlusion prior to balloon dilatation, angiographic parameters (namely, corrected TIMI frame count and myocardial blush grade) and ST-segment resolution were similar in the nitroprusside and control groups. 35 In the J-Wind trial, ANP reduced the infarct size, improved the ejection fraction and reduced reperfusion injury when administered at the time of PPCI; however, the rate of final TIMI grade 3 flow was similar in the ANP group and controls. 29 …”

mentioning

confidence: 99%

Pharmacological and physical prevention and treatment of no-reflow after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction

Guo

Sheng²,

Xu³

et al. 2013

J Int Med Res

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After successful primary percutaneous coronary intervention in ST-segment elevation myocardial infarction, adequate myocardial reperfusion is not achieved in up to 50% of patients. This phenomenon of no-reflow is associated with a poor in-hospital and long-term prognosis. Four main factors are thought to contribute to the occurrence of no-reflow: ischaemic injury; reperfusion injury; distal embolization; susceptibility of the microcirculation to injury. This review evaluates the literature, and in particular the clinical trials, concerned with pharmacological and physical methods for prevention and treatment of no-reflow. A number of drugs may improve no-reflow experimentally and clinically, but some have not yet been associated with conclusive improvements in clinical outcome. The complex interacting factors in no-reflow make it unlikely that any single agent will be effective for all patients. Confirmed methods known to be beneficial in the prevention of no-reflow (such as aspirin therapy, chronic statin therapy, blood glucose control, thrombus aspiration in patients with a high thrombus burden and ischaemic preconditioning) should be offered to patients as often as possible, to prevent and treat no-reflow.

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“…Interestingly, in a recent randomized study aimed at comparing a strategy of immediate stenting vs delayed stenting, the authors showed a lower rate of CMVO and greater myocardial salvage index at 6 months in the deferred group, thus suggesting that leaving time form residual thrombus dissolution before stenting may play an important role in the prevention of CMVO. 73 Finally, the use of vasodilators, including verapamil, diltiazem, and nitroprusside 74,75 have been associated with improvement of flow by angiography, although clinical outcome data are lacking in calciumantagonists 74 or controversial for nitroprusside. 75 …”

Section: Before Catheterization Laboratorymentioning

confidence: 99%

“…73 Finally, the use of vasodilators, including verapamil, diltiazem, and nitroprusside 74,75 have been associated with improvement of flow by angiography, although clinical outcome data are lacking in calciumantagonists 74 or controversial for nitroprusside. 75 …”

Section: Before Catheterization Laboratorymentioning

confidence: 99%

Pathophysiological aspects and management workflow of coronary microvascular obstruction in ST-segment elevation myocardial infarction

2016

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Restoring blood flow to ischemic but viable myocardium and reducing infarct size constitute the goals of reperfusion therapy with fibrinolytic drugs or primary percutaneous intervention in patients with ST-segment elevation myocardial infarction (STEMI). However, in a sizable proportion of patients, this intervention gains to reopen the obstructed epicardial coronary artery but does not achieve myocardial reperfusion because of coronary microvascular obstruction phenomenon (CMVO). In the last years, consistent evidence has pointed out how CMVO has a negative impact on outcome in patients with acute STEMI. Of note, most of the trials in this setting, mainly targeting reperfusion damage, have failed to show beneficial effects. In this article we provide a revision of mechanisms, diagnosis and prognosis of CMVO in acute STEMI, also pointing out the need of an integrated approach in order to prevent and treat CMVO in the different time windows of the acute event.

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Intracoronary nitroprusside for the prevention of the no-reflow phenomenon after primary percutaneous coronary intervention in acute myocardial infarction. A randomized, double-blind, placebo-controlled clinical trial

Cited by 106 publications

References 22 publications

Pharmacological Intervention for Prevention of Left Ventricular Remodeling and Improving Prognosis in Myocardial Infarction

Pharmacological Intervention for Prevention of Left Ventricular Remodeling and Improving Prognosis in Myocardial Infarction

Pharmacological and physical prevention and treatment of no-reflow after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction

Pathophysiological aspects and management workflow of coronary microvascular obstruction in ST-segment elevation myocardial infarction

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