No Reflow Phenomenon, ST Segment Elevation Myocardial Infarction (STEMI)
Conditions
Keywords
STEMI, No-reflow, Adrenaline, Prophylaxis
Brief summary
The aim of this work is to study the role of intracoronary adrenaline administration as a preventive tool for no reflow in patients undergoing primary PCI. The main question it aims to answer is: Do prohylcatic intrcoronary adrenaline reduce the incidence of no reflow without increaing risk of arrhythmia in primary PCI? The procedure will be performed by expert operators. All patients will receive the guidelines-directed recommendations of intervention of STEMI patients. Study group wil receive Intracoronary 10 mcg adrenaline via the guiding catheter after restoration of epicardial coronary flow of the culprit vessel and achievement of TIMI I flow either after wiring and/or passage of a deflated balloon and/or PTCA with a small balloon, and/or use of thrombus aspiration and before stenting. All steps in the Cath-lab will be described in detail: The primary end points will be improvement in coronary flow, as assessed by TIMI (Thrombolysis in Myocardial Infarction) flow, and myocardial blush. Secondary end points will be in-hospital mortality and major adverse cardiac events.
Interventions
DRUGAdrenaline
Intracoronary 10 mcg adrenaline will be given via the guiding catheter in study group after restoration of epicardial coronary flow of the culprit vessel and achievement of TIMI I flow either after wiring and/or passage of a deflated balloon and/or PTCA with a small balloon, and/or use of thrombus aspiration and before stenting.
Sponsors
Ain Shams University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Patients who are 18 years or older 2. Patients presenting with acute coronary syndrome with ECG criteria diagnostic of STEMI (according to the universal definition of myocardial infarction) within 12 hours from the onset of symptoms and treated by successful primary PCI.
Exclusion criteria
1. Age \< 18 years 2. Pregnant females. 3. Patients refused to give consent. 4. Patients who had normal coronary angiography. 5. Patients who had CTO lesions. 6. Patients who have SCAD. 7. Patients who developed dissection or mechanical complication during the procedure. 8. Patients presenting with cardiogenic shock. 9. Cardiomyopathies 10. Contraindications to epinephrine as HTN with SBP \>180 mmHg or DBP\>110 mmHg, clinically significant arrhythmia (Atrial fibrillation with rapid ventricular rate, ventricular tachycardia, or ventricular fibrillation) prior to PCI, known allergy to epinephrine.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| No-relow | 1 year up to 2 years | The primary end points will be improvement in coronary flow, as assessed by TIMI (Thrombolysis in Myocardial Infarction) flow Thrombolysis in Myocardial Infarction risk score (TIMI) flow grading system as following: * TIMI 0 = No ante-grade flow beyond the point of occlusion. * TIMI 1 = Faint ante-grade flow beyond the point of occlusion with incomplete filling of the distal vascular bed. * TIMI 2 = Delayed or sluggish ante-grade flow with complete filling of the distal vascular beds. * TIMI 3 = Normal flow with complete filling of the distal vascular bed Coronary no-reflow (CNR) is diagnosed immediately after PCI when post-procedural angiographic TIMI flow is \< 3 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| MACE | 1 year up to 2 years | Secondary end points will be major adverse cardiac events. |
Countries
Egypt
Contacts
Primary ContactMostafa Abdallah Khalifa, Master cardiology
Outcome results
None listed