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Year : 2021  |  Volume : 10  |  Issue : 2  |  Page : 1-7

Prophylactic use of intracoronary sodium nitroprusside decreases incidence of no reflow after primary angioplasty in acute myocardial infarction

Department of Cardiology, Lourdes Hospital, Pachalam P.O., Ernakulam 682012, Kerala, India

Correspondence Address:
Dr. Sujith Kumar
Department of Cardiology, Lourdes Hospital, Pachalam P.O., Ernakulam 682012, Kerala.
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/khj.khj_8_21

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Background: Intracoronary vasodilators are used in various stages of primary angioplasty, either to treat no reflow or prophylactically to prevent no reflow. Vasodilators were ineffective during primary angioplasty to treat no reflow likely because the drug was used after plaque modification. We evaluated the intracoronary use of sodium nitroprusside (SNP) before plaque modification and microembolization. Materials and Methods: We conducted a retrospective case–control study of all primary angioplasty cases done at Lourdes Hospital, Kerala, India, from March 2016 to May 2018 by two operators at the hospital. We retrospectively collected the data for primary angioplasty at the hospital and analyzed the data into two groups: one operator routinely used prophylactic intracoronary SNP in stable primary percutaneous coronary intervention (PCI) patients, whereas the other used it only if there was no reflow. The drug was delivered prophylactically through guiding catheter once at least TIMI I flow was present. We compared the effect of prophylactic vs. therapeutic use of intracoronary SNP on no reflow during primary percutaneous transluminal coronary angioplasty (PTCA). Results: Incidence of no reflow was significantly less in the group in which SNP was used at the onset of primary PTCA when compared with those patients in whom it was not used at the onset (6.5% vs. 28.4%, P < 0.001). The TIMI frame count (21.7 vs. 24, P = 0.22) and low TIMI myocardial perfusion grade (<2) (14% vs. 20%, P = 0.272) did not reach statistical significance. Conclusion: Prophylactic intracoronary use of SNP, before plaque modification, reduces the incidence of no reflow phenomenon after primary angioplasty.

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