Combination therapy reduces the incidence of no-reflow after primary percutaneous coronary intervention in patients with ST-segment elevation acute myocardial infarction

Background No-reflow is associated with an adverse outcome and higher mortality in patients with ST-segment elevation acute myocardial infarction(STEMI) who undergo percutaneous coronary intervention(PCI) and is considered a dynamic process characterized by multiple pathogenetic components.The aim of this study was to investigate the effectiveness of a combination therapy for the prevention of no-reflow in patient with acute myocardial infarction(AMI) undergoing primary PCI.Methods A total of 621 patients with STEMI who underwent emergency primary PCI were enrolled in this study.Patients with high risk of no-reflow(no-flow score > 10,by using a no-flow risk prediction model,n = 216) were randomly divided into a controlled group(n = 108) and a combination therapy group(n = 108).Patients in the controlled group received conventional treatment,while patients in combination therapy group received high-dose(80 mg) atorvastatin pre-treatment,mtracoronary administration of adenosine(140 μg/min per kilogram) during PCI procedure,platelet membrane glycoproteinⅡb/Ⅲa receptor antagonist(tirofiban,10μg/kg bolus followed by 0.15 μg/kg per minute) and thrombus aspiration.Myocardial contrast echocardiography was performed to assess the myocardial perfusion 72 h after PCI.Major adverse cardiac events(MACE) were followed up for six months.Results Incidence of no-reflow in combination therapy group was 2.8%,which was similar to that in low risk group 2.7%and was significantly lower than that in control group(35.2%,P < 0.01).The myocardial perfusion(A ×β) values were higher in combination therapy group than that in control group 72 h after PCI.After 6 months,there were six(6.3%) MACE events(one death,two non-fatal MIs and three revascularizations) in combination therapy group and 12(13.2%)(four deaths,three non-fatal MIs and five revascularizations,P < 0.05) in control group.Conclusions Combination of thrombus aspiration,high-dose statin pre-treatment,intracoronary administration of adenosine during PCI procedure and platelet membrane glycoprotein Ⅱ b/Ⅲa receptor antagonist reduces the incidence of no-reflow after primary PCI in patients with acute myocardial infarction who are at high risk of no-reflow.