Early Administration of Intracoronary Nitroprusside Compared with Thrombus Aspiration in Myocardial Perfusion for Acute Myocardial Infarction: A 3-Year Clinical Follow-Up Study.
BACKGROUND
Intracoronary nitroprusside and thrombus aspiration have been demonstrated to improve myocardial perfusion during percutaneous coronary interventions (PCI) for ST-segment elevation acute myocardial infarction (STEMI) However, no long-term clinical studies have been performed comparing these approaches.


METHODS
A single medical center retrospective study was conducted to evaluate the effects of intracoronary nitroprusside administration before slow/no-reflow phenomena versus thrombus aspiration during primary PCI. Forty-three consecutive patients with STEMI were enrolled in the intracoronary nitroprusside treatment group. One hundred twenty-four consecutive STEMI patients who received thrombus aspiration were enrolled; ninety-seven consecutive STEMI patients who did not receive either thrombus aspiration or intracoronary nitroprusside treatment were enrolled and served as control subjects. Patients with cardiogenic shock, who had received platelet glycoprotein IIb/IIIa inhibitor, or intra-aortic balloon pump insertion were excluded. Thrombolysis in Myocardial Infarction (TIMI) flow grade, corrected TIMI frame count and TIMI myocardial perfusion grade (TMPG) were assessed prior to and following PCI by two independent cardiologists blinded to the procedures. The rate of major adverse cardiac events (MACE) at 30 days, 1 year, and 3 years after study enrollment as a composite of recurrent myocardial infarction, target-vessel revascularization, and cardiac death were recorded.


RESULTS
The control group had a significantly lower pre-PCI TIMI flow (≤ 1; 49.5% vs. 69.8% vs. 77.4%; p = < 0.001) compared with the nitroprusside and thrombus aspiration groups. The thrombus aspiration group had a significantly higher pre-PCI thrombus score (> 4; 98.4% vs. 88.4% vs. 74.3%; p = < 0.001) and post-PCI TMPG (3; 39.5% vs. 16.3% vs. 20.6%; p = 0.001) compared with the nitroprusside and control groups. No significant differences were noted in the post-PCI thrombus score, 30-day, 1-year and 3-year MACE rate, and Kaplan-Meier curve among 3 groups of patients.


CONCLUSIONS
Although thrombus aspiration provided improved TMPG compared with early administration of intracoronary nitroprusside and neither of both during primary PCI, it did not have a significant impact on 30-day, 1-year and 3-year MACE rate.


BACKGROUND
Acute myocardial infarction; Intracoronary nitroprusside; Thrombus aspiration.
Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital; ; Chang Gung University College of Medicine;
Wei-Chieh
WC
Lee
Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital; ; Chang Gung University College of Medicine;
Shyh-Ming
SM
Chen
Chang Gung University College of Medicine; ; Emergency Department, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Chu-Feng
CF
Liu
Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital; ; Chang Gung University College of Medicine;
Chien-Jen
CJ
Chen
Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital; ; Chang Gung University College of Medicine;
Wen-Jung
WJ
Chung
Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital; ; Chang Gung University College of Medicine;
Shu-Kai
SK
Hsueh
Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital; ; Chang Gung University College of Medicine;
Tzu-Hsien
TH
Tsai
Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital; ; Chang Gung University College of Medicine;
Hsiu-Yu
HY
Fang
Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital; ; Chang Gung University College of Medicine;
Hon-Kan
HK
Yip
Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital; ; Chang Gung University College of Medicine;
Chi-Ling
CL
Hang