title: Effect of chronic pretreatment of angiotensin-converting receptor blocker on no-reflow phenomenon in patients with acute myocardial infarction undergoing percutaneous coronary intervention.
abstract: OBJECTIVE
  Angiotensin receptor blockers (ARBs) exert favorable effects on the vascular system, which are not directly related to hypertension lowering function. The no-reflow phenomenon determines the prognosis in patients after acute myocardial infarction (AMI). Early ARB treatment has many beneficial effects on the prognosis after AMI. In this study, we tested the hypothesis that ARB treatment before admission would have beneficial effects on the development of the no-reflow phenomenon after infarction.
  
  
  METHODS
  We investigated 276 consecutive patients with AMI undergoing successful primary percutaneous coronary intervention (PCI). No-reflow was defined as thrombolysis in myocardial infarction (TIMI) flow grade <3, which was determined by the TIMI frame count method using angiographic images obtained just after PCI and stenting.
  
  
  RESULTS
  Compared with patients without ARB treatment, patients with ARB had more frequently hypertension and ST resolution (P < 0.05), but no significant difference was found in the other clinical characteristics (age, sex, Hyperlipidaemia, Diabetes mellitus, etc) between the two groups. A total of 51 patients receiving chronic ARB treatment before admission have lower incidence of the no-reflow phenomenon than those without chronic ARB treatment (8.7% and 26.7%, P= 0.003). However, the incidence of the no-reflow phenomenon between the patients with and without hypertension had no significant difference. Multivariable logistic regression analysis revealed that ARB pretreatment was a significant predictor of the no-reflow phenomenon, whereas blood pressure was found to be insignificant.
  
  
  CONCLUSIONS
  Chronic pretreatment of ARB is associated with the reduction of the no-reflow phenomenon in patients with reperfused AMI and could preserve microvascular integrity after AMI independent of blood pressure lowering, which may contribute to better functional recovery.
authors.affiliation: Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Hu
authors.forename: Hai-Chang
authors.initials: HC
authors.lastname: Wang
authors.forename: Ru-Tao
authors.initials: RT
authors.lastname: Wang
authors.forename: An-Lin
authors.initials: AL
authors.lastname: Lv
authors.forename: Rong-Hua
authors.initials: RH
authors.lastname: Luan
authors.forename: Cheng-Xiang
authors.initials: CX
authors.lastname: Li
authors.forename: He-Xiang
authors.initials: HX
authors.lastname: Cheng
authors.forename: Cheng-Hai
authors.initials: CH
authors.lastname: Xia
authors.forename: Ling
authors.initials: L
authors.lastname: Tao
mesh_terms: D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy*; D054318:No-Reflow Phenomenon / Q000503:physiopathology / Q000628:therapy*; D062645:Percutaneous Coronary Intervention
chemical_list: D057911:Angiotensin Receptor Antagonists