Comparison of effect of intracoronary nitrate vs adenosine in TIMI flow in patients of STEMI undergoing primary PCI

Effect of intracoronary nitrate vs adenosine in patients of STEMI

Abstract

BACKGROUND & OBJECTIVE: The no-reflow phenomenon during primary percutaneous coronary intervention (PCI) remains a serious complication associated with increased morbidity and mortality in patients with ST-elevation myocardial infarction (STEMI). Recent evidence suggests that intracoronary nitrates may improve coronary perfusion through vasodilatory and antioxidant effects. This study compared the efficacy of intracoronary nitrates and adenosine on TIMI flow in STEMI patients with refractory no-reflow after primary PCI.

METHODOLOGY: This comparative study included 66 STEMI patients with refractory no-reflow during primary PCI, divided equally into two groups (33 each). Patients with cardiogenic shock at admission or known allergy to nitrates or adenosine were excluded. Group A received intracoronary adenosine (maximum dose 120 mcg), while Group B received intracoronary isosorbide dinitrate 200 mcg in a 10 ml solution. The study was approved by the Drug Regulatory Authority of Pakistan (DRAP) (Study Identifier: RCTS-0107; Case Number: 0230).

RESULTS: The mean age was 49.15 ± 8.47 years in Group A and 51.79 ± 7.22 years in Group B. Of the 66 patients, 35 (53.03%) were men and 31 (46.97%) were women. After 30 days, efficacy was observed in 31 patients (93.94%) in the nitrate group compared with 23 patients (69.70%) in the adenosine group.