title: Open-label, randomized, placebo-controlled evaluation of intracoronary adenosine or nitroprusside after thrombus aspiration during primary percutaneous coronary intervention for the prevention of microvascular obstruction in acute myocardial infarction: the REOPEN-AMI study (Intracoronary Nitroprusside Versus Adenosine in Acute Myocardial Infarction).
abstract: OBJECTIVE
  This study sought to assess whether intracoronary adenosine or nitroprusside following thrombus aspiration (TA) is superior to TA alone for the prevention of microvascular obstruction (MVO) in ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  MVO, due to its multifactorial pathogenesis, still occurs after TA in a sizeable portion of patients.
  
  
  METHODS
  We performed a placebo-controlled, randomized, open-label, blind-examination, multicenter trial. A total of 240 STEMI patients with Thrombolysis In Myocardial Infarction (TIMI) flow grade 0/1 were randomly allocated 1:1:1 to receive adenosine (n = 80), nitroprusside (n = 80), or saline (n = 80) given distal to the occluded site after TA. The primary endpoint was the incidence of ST-segment resolution (STR) >70% on surface electrocardiogram at 90 min after PCI. Secondary endpoints were angiographic MVO incidence (TIMI flow grade ≤2 or 3 with a myocardial blush grade <2) and major adverse cardiac event (MACE) rate at 30 days as a composite of cardiac death, myocardial infarction, target lesion revascularization, and heart failure requiring hospitalization.
  
  
  RESULTS
  STR >70% occurred in in 71% of adenosine-treated patients, in 54% of nitroprusside-treated patients, and in 51% of saline-treated patients (p = 0.009 and p = 0.75, respectively, vs. saline). Angiographic MVO occurred in 18% of adenosine-treated patients, in 24% of nitroprusside-treated patients, and in 30% of saline-treated patients (p = 0.06 and p = 0.37, respectively, vs. saline). MACE occurred in 10%, 14%, and 20% of patients, respectively (p = 0.08 and p = 0.29 vs. saline).
  
  
  CONCLUSIONS
  In STEMI patients treated by PCI and TA, the additional intracoronary administration of adenosine, but not that of nitroprusside, results in a significant improvement of MVO, as assessed by STR.
authors.affiliation: Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy. gniccoli73@hotmail.it
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Niccoli
authors.forename: Stefano
authors.initials: S
authors.lastname: Rigattieri
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: De Vita
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Corvo
authors.forename: Franco
authors.initials: F
authors.lastname: Fabbiocchi
authors.forename: Enrico
authors.initials: E
authors.lastname: Romagnoli
authors.forename: Alberto Ranieri
authors.initials: AR
authors.lastname: De Caterina
authors.forename: Giuseppe
authors.initials: G
authors.lastname: La Torre
authors.forename: Paolo
authors.initials: P
authors.lastname: Lo Schiavo
authors.forename: Fabio
authors.initials: F
authors.lastname: Tarantino
authors.forename: Roberto
authors.initials: R
authors.lastname: Ferrari
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Tomai
authors.forename: Paolo
authors.initials: P
authors.lastname: Olivares
authors.forename: Nicola
authors.initials: N
authors.lastname: Cosentino
authors.forename: Domenico
authors.initials: D
authors.lastname: D'Amario
authors.forename: Antonio Maria
authors.initials: AM
authors.lastname: Leone
authors.forename: Italo
authors.initials: I
authors.lastname: Porto
authors.forename: Francesco
authors.initials: F
authors.lastname: Burzotta
authors.forename: Carlo
authors.initials: C
authors.lastname: Trani
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
mesh_terms: D000241:Adenosine / Q000008:administration & dosage*; D000368:Aged; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000187:drug effects*; D004334:Drug Administration Schedule; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D007558:Italy; D008297:Male; D008833:Microcirculation / Q000187:drug effects*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D009599:Nitroprusside / Q000008:administration & dosage*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000401:mortality; D012008:Recurrence; D013396:Suction; D017131:Thrombectomy / Q000009:adverse effects / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D014664:Vasodilation / Q000187:drug effects*; D014665:Vasodilator Agents / Q000008:administration & dosage*
chemical_list: D014665:Vasodilator Agents; D009599:Nitroprusside; D000241:Adenosine