Nitroprusside for Prevention of no-Reflow in Primary Angioplasty

Intracoronary Nitroprusside for the Prevention of the No-Reflow Phenomenon Following Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction. A Randomized, Double Blind, Placebo-Controlled Clinical Trial

In patients admitted with acute myocardial infarction, there is a total occlusion of a coronary artery. Even after emergency catheterization and angioplasty, in some patients, the resumed blood flow is suboptimal and impacts on heart function. The study is aimed at examining whether nitroprusside, an anti-hypertension medication, given directly into the coronary artery, can improve the blood flow after the removal of the obstruction that caused the infarction.

Inadequate myocardial tissue perfusion despite successful relief of the culprit occlusion and restoration of epicardial coronary flow for ST-segment elevation acute myocardial infarction (STEMI) results in poor outcome. The investigators hypothesized that nitroprusside (NTP) injected intracoronary immediately before angioplasty might prevent no-reflow and improve vessel flow and myocardial perfusion.

Inclusion Criteria:

• Acute ST elevation myocardial infarction (MI) patients planned for primary PCI
• Diagnostic angiography demonstrating a TIMI flow grade <3 in the coronary artery before the PCI

Exclusion Criteria:

• An admission electrocardiogram (ECG) showing complete left bundle branch block or a paced rhythm
• Systolic blood pressure < 90 mmHg
• A history of coronary bypass operation
• A known allergic reaction to nitroprusside
• Chronic hemodialysis
• Intravenous drug abuse
• Pregnancy
• Rescue intervention after failed thrombolysis
• Contraindications to aspirin or clopidogrel
• Need for emergent coronary artery bypass surgery
• Inability to provide informed consent