Intracoronary pressure gradient measurement in acute myocardial infarction patients with the no-reflow phenomenon during primary percutaneous coronary intervention

Sodium nitroprusside injection immediately before balloon inflation during percutaneous coronary intervention

BACKGROUND

No reflow or slow flow frequently occurs during percutaneous coronary inter-vention (PCI) and it is associated with adverse outcomes. Strategies should be undertaken to prevent its occurrence.

AIM

To observe whether conventional target intracoronary administration of sodium nitroprusside immediately before balloon inflation can reduce the incidence of no reflow and slow flow, which are defined as thrombolysis in myocardial infarction flow grade ≤ II during PCI.

METHODS

A retrospective study was conducted in 740 patients with coronary artery disease admitted to Gansu Provincial Hospital of Traditional Chinese Medicine between January 2016 and October 2020. Among them, 360 patients receiving sodium nitroprusside immediately before balloon inflation during PCI were enrolled in an experimental group between January 2019 and October 2020 and 380 patients receiving sodium nitroprusside after incident no reflow and slow flow during PCI were enrolled in a control group between January 2016 and January 2019. The occurrence of no reflow and slow flow was compared between the two groups and left ventricular end-diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF) were detected 1 mo after the operation.

RESULTS

After treatment, the proportion of patients with thrombolysis in myocardial infarction flow grades 0 to II was lower in the experimental group than in the control group (P < 0.05). At 1 mo after treatment, LVEDD was lower and LVEF was higher in the experimental group than in the control group (P < 0.05). In terms of incidence of adverse cardiovascular events within 1 mo after treatment, in the experimental group, malignant arrhythmia occurred in three patients, intractable myocardial ischemia in three, congestive heart failure in four, and recurrent myocardial infarction in five; one patient died. In the control group, malignant arrhythmia occurred in eight patients, intractable myocardial ischemia in five, congestive heart failure in seven, and recurrent myocardial infarction in 14; two patients died. The incidence of adverse cardiovascular events was 4.4% in experimental group which was lower than that of the control group at 1 mo after operation (9.5%; P < 0.05).

CONCLUSION

Administration of sodium nitroprusside into target vessels immediately before balloon inflation can significantly reduce the incidence of no reflow and slow flow, improve LVEDD and LVEF, and reduce the incidence of adverse cardio-vascular events in patients treated by PCI. It is worthy of clinical promotion.