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.
BACKGROUND
The aim of this study was to test whether nitroprusside (NTP) injected intracoronary immediately before primary angioplasty for acute ST-elevation acute myocardial infarction (STEMI) prevents no-reflow and improves vessel flow and myocardial perfusion.


METHODS
Ninety-eight patients presenting with STEMI were evenly randomized to receive either NTP (60 microg) or placebo. The drug was selectively injected into the infarct-related artery, distal to the occlusion, in a double-blind manner. The primary end points were postintervention angiographic corrected thrombolysis in myocardial infarction frame count and the proportion of patients with complete (>70%) ST-segment elevation resolution. Secondary end points included myocardial blush score and clinical outcome at 6 months follow-up.


RESULTS
Mean (+/-SD) age was 62 (+/-12) years, and 87% were men. Baseline characteristics (excluding sex) did not differ between groups. The corrected thrombolysis in myocardial infarction frame count after angioplasty was 20.8 (+/-18.6) and 20.3 (+/-21.3) in patients given NTP and placebo, respectively (P = .78). Complete ST-segment resolution was achieved in 61.7% and 61.2% of NTP and placebo subjects, respectively (P = .96). The distribution of myocardial blush score did not differ between groups. At 6 months, the rate of target lesion revascularization, myocardial infarction, or death occurred in 6.3% of the NTP group and 20.0% of the placebo group (P = .05).


CONCLUSIONS
In patients with STEMI, selective intracoronary administration of a fixed dose of NTP failed to improve coronary flow and myocardial tissue reperfusion but improved clinical outcomes at 6 months.
Amit
Guy
G
Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Cafri
Carlos
C
Yaroslavtsev
Sergei
S
Fuchs
Shmuel
S
Paltiel
Ora
O
Abu-Ful
Akram
A
Weinstein
Jean M
JM
Wolak
Arik
A
Ilia
Reuben
R
Zahger
Doron
D
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003326:Coronary Circulation / Q000187:drug effects; D003331:Coronary Vessels / Q000187:drug effects*; D004311:Double-Blind Method; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000628:therapy; D015425:Myocardial Reperfusion / Q000379:methods; D009599:Nitroprusside / Q000008:administration & dosage*; D011300:Preoperative Care; D015912:Thrombolytic Therapy; D014665:Vasodilator Agents / Q000008:administration & dosage*
D014665:Vasodilator Agents; D009599:Nitroprusside