TY - JOUR
T1 - Open-label, randomized, placebo-controlled evaluation of intracoronary adenosine or nitroprusside after thrombus aspiration during primary percutaneous coronary intervention for the prevention of microvascular obstruction in acute myocardial infarction
T2 - The REOPEN-AMI study (intracoronary nitroprusside versus adenosine in acute myocardial infarction)
AU - Niccoli, Giampaolo
AU - Rigattieri, Stefano
AU - De Vita, Maria Rosaria
AU - Valgimigli, Marco
AU - Corvo, Pierfrancesco
AU - Fabbiocchi, Franco
AU - Romagnoli, Enrico
AU - De Caterina, Alberto Ranieri
AU - La Torre, Giuseppe
AU - Lo Schiavo, Paolo
AU - Tarantino, Fabio
AU - Ferrari, Roberto
AU - Tomai, Fabrizio
AU - Olivares, Paolo
AU - Cosentino, Nicola
AU - D'Amario, Domenico
AU - Leone, Antonio Maria
AU - Porto, Italo
AU - Burzotta, Francesco
AU - Trani, Carlo
AU - Crea, Filippo
PY - 2013/6
Y1 - 2013/6
N2 - Objectives This study sought to assess whether intracoronary adenosine or nitroprusside following thrombus aspiration (TA) is superior to TA alone for the prevention of microvascular obstruction (MVO) in ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI). Background MVO, due to its multifactorial pathogenesis, still occurs after TA in a sizeable portion of patients. Methods We performed a placebo-controlled, randomized, open-label, blind-examination, multicenter trial. A total of 240 STEMI patients with Thrombolysis In Myocardial Infarction (TIMI) flow grade 0/1 were randomly allocated 1:1:1 to receive adenosine (n = 80), nitroprusside (n = 80), or saline (n = 80) given distal to the occluded site after TA. The primary endpoint was the incidence of ST-segment resolution (STR) >70% on surface electrocardiogram at 90 min after PCI. Secondary endpoints were angiographic MVO incidence (TIMI flow grade ≤2 or 3 with a myocardial blush grade 70% occurred in in 71% of adenosine-treated patients, in 54% of nitroprusside-treated patients, and in 51% of saline-treated patients (p = 0.009 and p = 0.75, respectively, vs. saline). Angiographic MVO occurred in 18% of adenosine-treated patients, in 24% of nitroprusside-treated patients, and in 30% of saline-treated patients (p = 0.06 and p = 0.37, respectively, vs. saline). MACE occurred in 10%, 14%, and 20% of patients, respectively (p = 0.08 and p = 0.29 vs. saline). Conclusions In STEMI patients treated by PCI and TA, the additional intracoronary administration of adenosine, but not that of nitroprusside, results in a significant improvement of MVO, as assessed by STR.
AB - Objectives This study sought to assess whether intracoronary adenosine or nitroprusside following thrombus aspiration (TA) is superior to TA alone for the prevention of microvascular obstruction (MVO) in ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI). Background MVO, due to its multifactorial pathogenesis, still occurs after TA in a sizeable portion of patients. Methods We performed a placebo-controlled, randomized, open-label, blind-examination, multicenter trial. A total of 240 STEMI patients with Thrombolysis In Myocardial Infarction (TIMI) flow grade 0/1 were randomly allocated 1:1:1 to receive adenosine (n = 80), nitroprusside (n = 80), or saline (n = 80) given distal to the occluded site after TA. The primary endpoint was the incidence of ST-segment resolution (STR) >70% on surface electrocardiogram at 90 min after PCI. Secondary endpoints were angiographic MVO incidence (TIMI flow grade ≤2 or 3 with a myocardial blush grade 70% occurred in in 71% of adenosine-treated patients, in 54% of nitroprusside-treated patients, and in 51% of saline-treated patients (p = 0.009 and p = 0.75, respectively, vs. saline). Angiographic MVO occurred in 18% of adenosine-treated patients, in 24% of nitroprusside-treated patients, and in 30% of saline-treated patients (p = 0.06 and p = 0.37, respectively, vs. saline). MACE occurred in 10%, 14%, and 20% of patients, respectively (p = 0.08 and p = 0.29 vs. saline). Conclusions In STEMI patients treated by PCI and TA, the additional intracoronary administration of adenosine, but not that of nitroprusside, results in a significant improvement of MVO, as assessed by STR.
KW - IIb/IIIa antagonists
KW - intracoronary adenosine
KW - intracoronary nitroprusside
KW - manual thrombus aspiration
KW - primary percutaneous coronary intervention
KW - ST-segment elevation myocardial infarction
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U2 - 10.1016/j.jcin.2013.02.009
DO - 10.1016/j.jcin.2013.02.009
M3 - Article
C2 - 23683738
AN - SCOPUS:84879411789
VL - 6
SP - 580
EP - 589
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
SN - 1936-8798
IS - 6
ER -