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Treatment of Slow-Flow After Primary Percutaneous Coronary Intervention With Flow-Mediated Hyperemia: The Randomized

Josep Gomez-Lara1, Montserrat Gracida1, Fernando Rivero2

  • 1Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L' Hospitalet de Llobregat Barcelona Spain.

Journal of the American Heart Association
|June 22, 2023
PubMed

Insights

Neither pharmacologic nor flow-mediated hyperemia effectively restored coronary flow in ST-segment-elevation myocardial infarction patients experiencing no reflow. Both treatments demonstrated similar, limited efficacy, highlighting the need for improved strategies to manage no reflow complications.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Microcirculation Research

Background:

  • No reflow phenomenon post-primary percutaneous coronary intervention in ST-elevation myocardial infarction is linked to adverse clinical outcomes.
  • Current treatments for no reflow, despite improving Thrombolysis in Myocardial Infarction flow, remain suboptimal.
  • Flow-mediated hyperemia induced by saline infusion presents a novel approach to managing no reflow.

Purpose of the Study:

  • To compare the efficacy of pharmacologic hyperemia versus flow-mediated hyperemia in improving coronary flow in ST-elevation myocardial infarction patients with no reflow.
  • To assess microcirculatory resistance and Thrombolysis in Myocardial Infarction frame count following interventions.
  • To evaluate the diagnostic potential of thermodilution patterns during flow-mediated hyperemia.

Main Methods:

  • The RAIN-FLOW study randomized 67 patients with ST-elevation myocardial infarction and no reflow.
  • Intervention groups included pharmacologic hyperemia (adenosine or nitroprusside) and flow-mediated hyperemia (saline infusion).
  • Outcomes measured included angiographic corrected Thrombolysis in Myocardial Infarction frame count and minimal microcirculatory resistance using thermodilution and pressure-thermistor wire.

Main Results:

  • No significant difference was observed in Thrombolysis in Myocardial Infarction frame count (40.2±23.1 vs. 39.2±20.7, P=0.858) or minimal microcirculatory resistance (753.6±661.5 vs. 993.3±740.8 Wood units, P=0.174) between the groups.
  • The rates of Thrombolysis in Myocardial Infarction 3 flow were similar (26.7% vs. 27.0%, P=0.899).
  • Flow-mediated hyperemia revealed distinct thermodilution patterns indicating no reflow severity.

Conclusions:

  • Both pharmacologic and flow-mediated hyperemia demonstrated limited and comparable efficacy in restoring coronary flow.
  • Flow-mediated hyperemia, coupled with thermodilution, offers a method to characterize no reflow severity and treatment response.
  • No reflow in ST-elevation myocardial infarction is associated with high rates of in-hospital adverse events, necessitating further research for prevention and treatment.

Keywords:
ST‐segment‐elevation myocardial infarctionabsolute coronary blood flowhyperemiano reflow phenomenonprimary percutaneous coronary intervention

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