Authors: Parikh, Keyur H.; Chag, Milan C.; Shah, Kanan J.; Shah, Urmil G.; Baxi, Hemang A.; Chandarana, Anish H.; Naik, Ajay M.; Shah, Joyal N.; Shah, Hetal D.; Goyal, Ramesh K.

Source: Canadian Journal of Physiology and Pharmacology, Volume 85, Numbers 3-4, March 2007 , pp. 476-482(7)

Publisher: NRC Research Press

Abstract:

No or slow reflow following percutaneous coronary intervention (PCI), despite the presence of a patent epicardial vessel, is a serious complication resulting in increased morbidity and mortality. In the present study, we have evaluated the combination therapy of adenosine and sodium nitroprusside administered as sequential intracoronary (IC) boluses on no-reflow during PCI. Seventy-five high risk acute coronary syndrome patients who underwent PCI with evidence of initial less than TIMI (thrombolysis in myocardial infarction) III flow or developed deterioration in TIMI flow during the procedure were randomized to prophylactic administration of multiple boluses of IC saline solution, adenosine (12μg/bolus) or the combination of adenosine (12μg/bolus) and sodium nitroprusside (50μg/bolus), sequentially. Assessment of TIMI and the TMP (tissue myocardial perfusion) grade was done and major adverse cardiac events (MACE) were assessed at the end of 6 months. Slow or no-reflow was persistent in 70% patients receiving saline solution, 31% patients receiving adenosine, and 4% patient receiving the combination. IC injection with saline solution did not produce improvement in TIMI flow or TMP grade. IC injection with combination resulted in greater improvement of TIMI flow and TMP grade. The crossover of patients with no-reflow in saline solution group or adenosine with combination treatment was associated with reestablishment of TIMI II in 4 and TIMI III in 20 patients. Our data suggest that combination therapy of adenosine and nitroprusside is safe and provides better improvement in coronary flow and MACE as compared with IC adenosine alone in cases of impaired flow during coronary interventions.

L'absence de reperfusion ou une reperfusion lente durant une intervention coronaire percutanée (ICP), malgré la présence d'un vaisseau épicardique perméable, est une complication sérieuse provoquant un taux élevé de morbidité et de mortalité. Dans la présente étude, nous avons évalué la polythérapie associant l'adénosine et le nitroprussiate de sodium, administrés en bolus intra-coronaires (i.c.) séquentiels en l'absence de reperfusion durant une ICP. Soixante-quinze patients à haut risque du syndrome coronaire aigu, ayant subi une ICP avec un flux initial inférieur au flux TIMI (thrombolyse durant l'infarctus du myocarde) III ou ayant présenté une détérioration du flux TIMI durant l'intervention, ont été soumis aléatoirement à l'administration prophylactique de multiples bolus i.c. séquentiels de solution saline, d'adénosine (12 μg/bolus) ou de l'association adénosine (12 μg/bolus) et nitroprussiate de sodium (50 μg/bolus). On a évalué le grade du flux TIMI et de la TMP (perfusion myocardique) ainsi que les principaux événements cardiaques indésirables (MACE) au bout de 6 mois. L'absence de reperfusion ou la reperfusion lente a persisté chez 70 % des patients ayant reçu la solution saline, 31 % des patient ayant reçu l'adénosine et 4 % des patients ayant reçu l'association médicamenteuse. L'injection i.c. de la solution saline n'a pas amélioré le grade du flux TIMI ou de la TMP. L'injection i.c. de l'association médicamenteuse a amélioré le grade du flux TIMI ou de la TMP. Le croisement des patients avec absence de reperfusion chez le groupe solution saline ou adénosine et association médicamenteuse a été relié au rétablissement du flux TIMI II et TIMI III chez 20 patients. Nos résultats donnent à penser qu'une polythérapie associant adénosine et nitroprussiate de sodium est sans danger et plus efficace que l'adénosine i.c. seule pour améliorer le flux coronaire et diminuer les MACE en cas d'altération du flux durant les interventions coronaires.

Document Type: Research article

Publication date: 2007-03-01

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• By this author: Parikh, Keyur H. ;  Chag, Milan C. ;  Shah, Kanan J. ;  Shah, Urmil G. ;  Baxi, Hemang A. ;  Chandarana, Anish H. ;  Naik, Ajay M. ;  Shah, Joyal N. ;  Shah, Hetal D. ;  Goyal, Ramesh K.

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