Impact of PercuSurge device conjugative with intracoronary administration of nitroprusside on no-reflow phenomenon following primary percutaneous coronary intervention

Background The present study tested the hypothesis that when administered in conjunction with a PercuSurge device for treatment of acute myocardial infarction (AMI), intracoronary (IC) administration of nitroprusside (NTP) is safe and superior to IC administration of NTP alone or nitroglycerin (NTG) for reversing slow-flow or no-reflow, both of which occur frequently during primary percutaneous coronary intervention (PCI). Methods and Results Sixty-two patients with ST-segment elevation AMI of < 12h duration undergoing primary PCI were enrolled. When the final Thrombolysis In Myocardial Infarction (TIMI) flow was normal (TIMI-3), NTG 200 mu g was administered first, followed by (5 min later) NTP 100,mu g via an intra-guiding catheter. When final TIMI flow was <= 2, NTG 200 mu g was given, followed by NTP 100 mu g via an export suction catheter advanced into the infract-related artery (IRA). Primary endpoint was epicardial blood flow (TIMI-flow), corrected TIMI frame counts, or microvascular circulation [myocardial blush (MB) grade]. Analytical results indicated that the final TIMI-3 flow was significantly higher in patients receiving NTP than in those receiving NTG therapy (100% vs 88.7%, p=0.023). As compared with NTG, NTP therapy significantly improved final MB grade (p < 0.0001) and corrected TIMI flame count time (p < 0.0001). Subgroup analysis demonstrated that final MB grade (p < 0.001) and corrected TIMI flame count time (p < 0.01) were significantly higher in patients (n=33) with than in patients (n=29) without the PercuSurge. No significant NTP related adverse events occurred, apart from insignificant transient hypotension. Conclusion IC administration of NTP is safe and superior to NTG for improving final epicardial blood flow and microvascular circulation in patients with AMI undergoing primary PCI. Combination therapy of PercuSurge device and NTP provided an additional benefit to NTP alone for improving microvascular circulation.