Prevention of Coronary Slow Flow or No-Reflow During PPCI in Patients With Acute STEMI

Prevention of Coronary Slow Flow or No-Reflow During Primary Percutaneous Coronary Intervention in Patients With Acute ST-segment Elevation Myocardial Infarction

Primary percutaneous coronary intervention (PPCI) is the gold standard of treatment of ST segment elevation myocardial infarction (STEMI).Slow flow / no-reflow phenomenon following PPCI in STEMI patients has been a serious and common complication that closely related to the incidence of major adverse cardiovascular events (MACE) and affected patients' prognosis. No reflow is a multi-factorial phenomenon. And its preventive and therapeutic effects are not satisfactory. This prospective randomized controlled study aimed to compare favorable effects of Nitroprusside versus Tirofiban on the prevention of slow flow / no-reflow phenomenon during PPCI.

Inclusion Criteria:

• Ischemic symptoms < 12h, or evidence of ongoing ischemia 12h after symptom onset
• Continued ischemic chest pain > 30min
• ST-segment elevation ≥ 0.1 millivolt in 2 or more contiguous leads on the 12-lead ECG or new left bundle branch block (LBBB)
• Detection of a rise of cardiac biomarker values with at least one value above the 99th percentile upper reference limit (URL)
• Primary coronary artery angiography was planned.

Exclusion Criteria:

• Emergency thrombolytic therapy was performed before primary coronary artery angiography
• Cardiogenic shock with no response to hypervolemic treatment or vasopressor
• Severe cardiomyopathy or valvular disease requiring intervention
• Coronary ectasia
• Severe heart failure
• Contraindication or allergy to antiplatelet drugs
• Contraindication or allergy to experimental drugs
• Unable to receive at least 1 year of dual antiplatelet therapy
• Active bleeding or extreme-risk for major bleeding
• Severe liver or renal failure
• Life expectancy < 1 year
• Unable or unwilling to provide informed consent
• Women of child bearing potential
• Under 18 years of age
• Hemoglobin < 90g/L
• Platelet count < 100×10^9/L
• Can not cooperate (with mental disorders or cognitive disorders)