The SALINE Technique for the Treatment of the No-Reflow Phenomenon during Percutaneous Coronary Intervention in STEMI

Area of Science:

• Cardiology
• Interventional Cardiology
• Acute Coronary Syndromes

Background:

• Primary percutaneous coronary intervention (pPCI) for ST-elevation myocardial infarction (STEMI) can be complicated by the "no-reflow" phenomenon.
• No-reflow impedes blood flow restoration despite successful coronary artery opening.

Purpose of the Study:

• To evaluate the efficacy of a super-selective intracoronary injection of saline solution (SALINE technique) versus standard care of therapy (SCT) for treating no-reflow in STEMI patients.
• To compare ST-segment resolution (STR), coronary flow restoration, and long-term adverse events between the two treatment groups.

Main Methods:

• A propensity score matching analysis was conducted on 168 STEMI patients who developed no-reflow during pPCI.
• Primary endpoints included STR ≥ 70% and TIMI flow grade 3 with myocardial blush grade (MBG) > 1.
• Secondary endpoint was major adverse cardiac and cerebrovascular events (MACCE) at 3-year follow-up.

Main Results:

• The SALINE technique achieved STR ≥ 70% in 75.0% of patients, significantly higher than SCT (19.0%, p < 0.004).
• Final TIMI flow grade 3 with MBG > 1 was observed in 87.5% of SALINE-treated patients versus 43.8% in the SCT group (p < 0.03).
• MACCE at 3 years occurred in 6.3% of SALINE patients compared to 50% in the SCT group (p = 0.047).

Conclusions:

• The SALINE technique is a safe and effective strategy for managing no-reflow in STEMI.
• This method significantly improves ST-segment resolution and coronary blood flow.
• SALINE treatment is associated with superior 3-year clinical outcomes compared to standard care.