title: Effect of intracoronary nitroprusside injection on flow recovery during primary PCI in acute STEMI patients.
abstract: BACKGROUND
  The no/slow reflow phenomenon during primary percutaneous coronary intervention (PPCI) causes the destruction of the coronary microcirculation and further myocardial damage. Some studies have shown that intracoronary nitroprusside infusion is a safe and effective method for managing the no/slow reflow phenomenon. However, it is uncertain whether the injection of nitroprusside at a specific time point during PPCI can most effectively prevent no-reflow. In this study, we investigated the effect of the timing of an intracoronary nitroprusside injection on flow recovery during PPCI in patients with ST elevation acute myocardial infarction (STEMI).
  
  
  METHODS
  One hundred twenty consecutive patients with STEMI who underwent PPCI were enrolled in the study. Patients who fulfilled the eligibility criteria were randomly allocated to three groups: control group (N.=40) received no nitroprusside before they completed PCI; the second group (N.=40) received nitroprusside before balloon dilatation; and the third group (N.=40) received nitroprusside after each balloon dilatation and before contrast agent refilling. The baseline clinical variables and the details of the PCI procedure were collected. The thrombolysis in myocardial infarction (TIMI) flow grades and the corrected TIMI frame count (cTFC) were evaluated immediately after stent implantation was completed.
  
  
  RESULTS
  There were no significant differences in the baseline characteristics, antithrombotic drugs given before PCI, and details of the PCI procedure among the three groups (P>0.05). The incidence of TIMI grade 3 after PCI was significantly higher in the nitroprusside group than in the control group (P=0.025), whereas cTFC was significantly lower in the nitroprusside group (26.6±15.2) than in the control group (38.1±21.3, P=0.001). The incidence of TIMI grade 3 after PCI was significantly higher in the third group than in the second group (P=0.045), and cTFC was significantly lower in the third group (21.5±9.5) than in the second group (31.2±18.3, P=0.002). Multivariable linear regression analyses showed that the intracoronary nitroprusside injection time was a significant predictor of cTFC after PCI.
  
  
  CONCLUSIONS
  These data suggest that the intracoronary injection of nitroprusside significantly reduced the incidence of no/slow reflow during PPCI. The intracoronary injection of nitroprusside most effectively prevented the no/slow reflow phenomenon when administered between balloon dilatation and contrast agent refilling during PPCI.
authors.affiliation: Department of Cardiology, Kunming General Hospital of Chengdu Military Command, Kunming, China.
authors.forename: Lixia
authors.initials: L
authors.lastname: Yang
authors.affiliation: Department of Emergency, Yunnan Provincial Emergency Center, Kunming, China.
authors.forename: Lihua
authors.initials: L
authors.lastname: Mu
authors.affiliation: Department of Medical Control, Kunming General Hospital of Chengdu Military Command, Kunming, China.
authors.forename: Linhui
authors.initials: L
authors.lastname: Sun
authors.affiliation: Department of Cardiology, Kunming General Hospital of Chengdu Military Command, Kunming, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Qi
authors.affiliation: Department of Cardiology, Kunming General Hospital of Chengdu Military Command, Kunming, China - grw771210@163.com.
authors.forename: Ruiwei
authors.initials: R
authors.lastname: Guo
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000208:Acute Disease; D000800:Angioplasty, Balloon; D003326:Coronary Circulation / Q000187:drug effects; D003331:Coronary Vessels; D007269:Injections, Intra-Arterial; D009599:Nitroprusside / Q000008:administration & dosage / Q000627:therapeutic use; D062645:Percutaneous Coronary Intervention / Q000379:methods; D000072657:ST Elevation Myocardial Infarction / Q000188:drug therapy / Q000628:therapy; D015607:Stents; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use; D011897:Random Allocation
chemical_list: D009599:Nitroprusside; D014665:Vasodilator Agents