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Strategies to attenuate micro-vascular obstruction during P-PCI: the randomized reperfusion facilitated by local

Sheraz A Nazir1, Gerry P McCann1, John P Greenwood2

  • 1Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK.

European Heart Journal
|May 6, 2016
PubMed
Abstract

Insights

Intra-coronary adenosine and sodium nitroprusside did not reduce infarct size or microvascular obstruction in ST-elevation myocardial infarction patients. Adenosine treatment was associated with increased adverse events and reduced ejection fraction.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiovascular Research

Background:

  • Microvascular obstruction (MVO) after primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) worsens outcomes.
  • Assessing novel treatments to mitigate MVO and infarct size is crucial for improving patient prognosis.

Purpose of the Study:

  • To evaluate the efficacy of intra-coronary (IC) high-dose adenosine or sodium nitroprusside (SNP) in reducing infarct size and MVO.
  • To assess the impact of these treatments on clinical outcomes up to 6 months post-STEMI.

Main Methods:

  • REFLO-STEMI trial: a prospective, open-label, multi-center study randomizing 247 STEMI patients (1:1:1) to IC adenosine, IC SNP, or standard PPCI.
  • Primary endpoint: infarct size (% LV mass) measured by cardiac magnetic resonance (CMR) 24-96 hours post-PPCI.
  • Secondary endpoints included MVO and clinical outcomes at 6 months.

Main Results:

  • No significant difference in infarct size or MVO was observed between adenosine, SNP, and control groups.
  • Per-protocol analysis showed increased infarct size in the adenosine group (12.0% vs. 8.3%, P=0.031).
  • Adenosine treatment was linked to higher major adverse cardiac events and reduced ejection fraction at 6 months.

Conclusions:

  • High-dose IC adenosine and SNP administered during PPCI do not reduce infarct size or MVO in STEMI patients.
  • Adenosine treatment may be associated with adverse mid-term clinical outcomes, warranting caution.
Keywords:
Acute myocardial infarctionAdenosineIschaemia-reperfusion injuryMagnetic resonance ImagingMicrovascular obstructionNitroprusside

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