Myocardial Infarction
Conditions
Keywords
myocardial infarction, angioplasty, nitric oxide, prevention, acute myocardial infarction
Brief summary
In patients admitted with acute myocardial infarction, there is a total occlusion of a coronary artery. Even after emergency catheterization and angioplasty, in some patients, the resumed blood flow is suboptimal and impacts on heart function. The study is aimed at examining whether nitroprusside, an anti-hypertension medication, given directly into the coronary artery, can improve the blood flow after the removal of the obstruction that caused the infarction.
Detailed description
Inadequate myocardial tissue perfusion despite successful relief of the culprit occlusion and restoration of epicardial coronary flow for ST-segment elevation acute myocardial infarction (STEMI) results in poor outcome. The investigators hypothesized that nitroprusside (NTP) injected intracoronary immediately before angioplasty might prevent no-reflow and improve vessel flow and myocardial perfusion.
Interventions
DRUGNitroprusside
Sponsors
Soroka University Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
PREVENTION
Masking
DOUBLE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* Acute ST elevation myocardial infarction (MI) patients planned for primary PCI * Diagnostic angiography demonstrating a TIMI flow grade \<3 in the coronary artery before the PCI
Exclusion criteria
* An admission electrocardiogram (ECG) showing complete left bundle branch block or a paced rhythm * Systolic blood pressure \< 90 mmHg * A history of coronary bypass operation * A known allergic reaction to nitroprusside * Chronic hemodialysis * Intravenous drug abuse * Pregnancy * Rescue intervention after failed thrombolysis * Contraindications to aspirin or clopidogrel * Need for emergent coronary artery bypass surgery * Inability to provide informed consent
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| The coronary blood flow in the artery undergoing intervention following angioplasty as determined by the corrected Thrombolysis in Myocardial Infarction (TIMI) frame count (CTFC) | — |
| Proportion of patients with complete ST-segment resolution immediately after percutaneous coronary intervention (PCI) | — |
Secondary
| Measure | Time frame |
|---|---|
| The proportion of patients with complete ST-segment resolution at 24 hours post intervention | — |
| The proportion of patients requiring intra-aortic balloon counter-pulsation and its duration of use | — |
| The proportion of patients with TIMI grade 3 flow after the procedure | — |
| The combined rate of target vessel revascularization, myocardial infarction or death at 180 days | — |
| Length of hospital stay | — |
| The proportion of patients with myocardial grade 3 blush after the procedure | — |
Countries
Israel
Outcome results
None listed