Treatment of Slow‐Flow After Primary Percutaneous Coronary Intervention With Flow‐Mediated Hyperemia: The Randomized RAIN‐FLOW Study
Background ST‐segment–elevation myocardial infarction complicated with no reflow after primary percutaneous coronary intervention is associated with adverse outcomes. Although several hyperemic drugs have been shown to improve the Thrombolysis in Myocardial Infarction flow, optimal treatment of no r...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-07-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.030285 |
| _version_ | 1797337879449436160 |
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| author | Josep Gomez‐Lara Montserrat Gracida Fernando Rivero Alejandro Gutiérrez‐Barrios Guillem Muntané‐Carol Rafael Romaguera Lara Fuentes Ana Marcano Gerard Roura José Luis Ferreiro Luis Teruel Salvatore Brugaletta Fernando Alfonso Josep Comín‐Colet Joan‐Antoni Gomez‐Hospital |
| author_facet | Josep Gomez‐Lara Montserrat Gracida Fernando Rivero Alejandro Gutiérrez‐Barrios Guillem Muntané‐Carol Rafael Romaguera Lara Fuentes Ana Marcano Gerard Roura José Luis Ferreiro Luis Teruel Salvatore Brugaletta Fernando Alfonso Josep Comín‐Colet Joan‐Antoni Gomez‐Hospital |
| author_sort | Josep Gomez‐Lara |
| collection | DOAJ |
| description | Background ST‐segment–elevation myocardial infarction complicated with no reflow after primary percutaneous coronary intervention is associated with adverse outcomes. Although several hyperemic drugs have been shown to improve the Thrombolysis in Myocardial Infarction flow, optimal treatment of no reflow remains unsettled. Saline infusion at 20 mL/min via a dedicated microcatheter causes (flow‐mediated) hyperemia. The objective is to compare the efficacy of pharmacologic versus flow‐mediated hyperemia in patients with ST‐segment–elevation myocardial infarction complicated with no reflow. Methods and Results In the RAIN‐FLOW (Treatment of Slow‐Flow After Primary Percutaneous Coronary Intervention With Flow‐Mediated Hyperemia) study, 67 patients with ST‐segment–elevation myocardial infarction and no reflow were randomized to receive either pharmacologic‐mediated hyperemia with intracoronary adenosine or nitroprusside (n=30) versus flow‐mediated hyperemia (n=37). The angiographic corrected Thrombolysis in Myocardial Infarction frame count and the minimal microcirculatory resistance, as assessed with intracoronary pressure‐thermistor wire, dedicated microcatheter, and thermodilution techniques, were compared after study interventions. Both Thrombolysis in Myocardial Infarction frame count(40.2±23.1 versus 39.2±20.7; P=0.858) and minimal microcirculatory resistance (753.6±661.5 versus 993.3±740.8 Wood units; P=0.174) were similar between groups. Thrombolysis in Myocardial Infarction 3 flow was observed in 26.7% versus 27.0% (P=0.899). Flow‐mediated hyperemia showed 2 different thermodilution patterns during saline infusion indicative of the severity of the no reflow phenomenon. In‐hospital death and nonfatal heart failure were observed in 10.4% and 26.9%, respectively. Conclusions Both treatments showed similar (and limited) efficacy restoring coronary flow. Flow‐mediated hyperemia with thermodilution pattern assessment allowed the simultaneous characterization of the no reflow degree and response to hyperemia. No reflow was associated with a high rate of adverse outcomes. Further research is warranted to prevent and to treat no reflow in patients with ST‐segment–elevation myocardial infarction. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04685941. |
| first_indexed | 2024-03-08T09:22:58Z |
| format | Article |
| id | doaj.art-6ca76e19ec0a4af5b896db23d1e35fa4 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-08T09:22:58Z |
| publishDate | 2023-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-6ca76e19ec0a4af5b896db23d1e35fa42024-01-31T11:31:17ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-07-01121310.1161/JAHA.123.030285Treatment of Slow‐Flow After Primary Percutaneous Coronary Intervention With Flow‐Mediated Hyperemia: The Randomized RAIN‐FLOW StudyJosep Gomez‐Lara0Montserrat Gracida1Fernando Rivero2Alejandro Gutiérrez‐Barrios3Guillem Muntané‐Carol4Rafael Romaguera5Lara Fuentes6Ana Marcano7Gerard Roura8José Luis Ferreiro9Luis Teruel10Salvatore Brugaletta11Fernando Alfonso12Josep Comín‐Colet13Joan‐Antoni Gomez‐Hospital14Hospital Universitari de Bellvitge, Institut d’ Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L’ Hospitalet de Llobregat Barcelona SpainHospital Universitari de Bellvitge, Institut d’ Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L’ Hospitalet de Llobregat Barcelona SpainHospital Universtiario La Princesa, Instituto de Investigación Sanitaria‐IP (IIS‐IP), CIBER‐CV Madrid SpainHospital Puerta del Mar Cádiz SpainHospital Universitari de Bellvitge, Institut d’ Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L’ Hospitalet de Llobregat Barcelona SpainHospital Universitari de Bellvitge, Institut d’ Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L’ Hospitalet de Llobregat Barcelona SpainHospital Universitari de Bellvitge, Institut d’ Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L’ Hospitalet de Llobregat Barcelona SpainHospital Universitari de Bellvitge, Institut d’ Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L’ Hospitalet de Llobregat Barcelona SpainHospital Universitari de Bellvitge, Institut d’ Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L’ Hospitalet de Llobregat Barcelona SpainHospital Universitari de Bellvitge, Institut d’ Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L’ Hospitalet de Llobregat Barcelona SpainHospital Universitari de Bellvitge, Institut d’ Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L’ Hospitalet de Llobregat Barcelona SpainHospital Clínic i Provincial de Barcelona Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Barcelona SpainHospital Universtiario La Princesa, Instituto de Investigación Sanitaria‐IP (IIS‐IP), CIBER‐CV Madrid SpainHospital Universitari de Bellvitge, Institut d’ Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L’ Hospitalet de Llobregat Barcelona SpainHospital Universitari de Bellvitge, Institut d’ Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L’ Hospitalet de Llobregat Barcelona SpainBackground ST‐segment–elevation myocardial infarction complicated with no reflow after primary percutaneous coronary intervention is associated with adverse outcomes. Although several hyperemic drugs have been shown to improve the Thrombolysis in Myocardial Infarction flow, optimal treatment of no reflow remains unsettled. Saline infusion at 20 mL/min via a dedicated microcatheter causes (flow‐mediated) hyperemia. The objective is to compare the efficacy of pharmacologic versus flow‐mediated hyperemia in patients with ST‐segment–elevation myocardial infarction complicated with no reflow. Methods and Results In the RAIN‐FLOW (Treatment of Slow‐Flow After Primary Percutaneous Coronary Intervention With Flow‐Mediated Hyperemia) study, 67 patients with ST‐segment–elevation myocardial infarction and no reflow were randomized to receive either pharmacologic‐mediated hyperemia with intracoronary adenosine or nitroprusside (n=30) versus flow‐mediated hyperemia (n=37). The angiographic corrected Thrombolysis in Myocardial Infarction frame count and the minimal microcirculatory resistance, as assessed with intracoronary pressure‐thermistor wire, dedicated microcatheter, and thermodilution techniques, were compared after study interventions. Both Thrombolysis in Myocardial Infarction frame count(40.2±23.1 versus 39.2±20.7; P=0.858) and minimal microcirculatory resistance (753.6±661.5 versus 993.3±740.8 Wood units; P=0.174) were similar between groups. Thrombolysis in Myocardial Infarction 3 flow was observed in 26.7% versus 27.0% (P=0.899). Flow‐mediated hyperemia showed 2 different thermodilution patterns during saline infusion indicative of the severity of the no reflow phenomenon. In‐hospital death and nonfatal heart failure were observed in 10.4% and 26.9%, respectively. Conclusions Both treatments showed similar (and limited) efficacy restoring coronary flow. Flow‐mediated hyperemia with thermodilution pattern assessment allowed the simultaneous characterization of the no reflow degree and response to hyperemia. No reflow was associated with a high rate of adverse outcomes. Further research is warranted to prevent and to treat no reflow in patients with ST‐segment–elevation myocardial infarction. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04685941.https://www.ahajournals.org/doi/10.1161/JAHA.123.030285absolute coronary blood flowhyperemiano reflow phenomenonprimary percutaneous coronary interventionST‐segment‐elevation myocardial infarction |
| spellingShingle | Josep Gomez‐Lara Montserrat Gracida Fernando Rivero Alejandro Gutiérrez‐Barrios Guillem Muntané‐Carol Rafael Romaguera Lara Fuentes Ana Marcano Gerard Roura José Luis Ferreiro Luis Teruel Salvatore Brugaletta Fernando Alfonso Josep Comín‐Colet Joan‐Antoni Gomez‐Hospital Treatment of Slow‐Flow After Primary Percutaneous Coronary Intervention With Flow‐Mediated Hyperemia: The Randomized RAIN‐FLOW Study Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease absolute coronary blood flow hyperemia no reflow phenomenon primary percutaneous coronary intervention ST‐segment‐elevation myocardial infarction |
| title | Treatment of Slow‐Flow After Primary Percutaneous Coronary Intervention With Flow‐Mediated Hyperemia: The Randomized RAIN‐FLOW Study |
| title_full | Treatment of Slow‐Flow After Primary Percutaneous Coronary Intervention With Flow‐Mediated Hyperemia: The Randomized RAIN‐FLOW Study |
| title_fullStr | Treatment of Slow‐Flow After Primary Percutaneous Coronary Intervention With Flow‐Mediated Hyperemia: The Randomized RAIN‐FLOW Study |
| title_full_unstemmed | Treatment of Slow‐Flow After Primary Percutaneous Coronary Intervention With Flow‐Mediated Hyperemia: The Randomized RAIN‐FLOW Study |
| title_short | Treatment of Slow‐Flow After Primary Percutaneous Coronary Intervention With Flow‐Mediated Hyperemia: The Randomized RAIN‐FLOW Study |
| title_sort | treatment of slow flow after primary percutaneous coronary intervention with flow mediated hyperemia the randomized rain flow study |
| topic | absolute coronary blood flow hyperemia no reflow phenomenon primary percutaneous coronary intervention ST‐segment‐elevation myocardial infarction |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.030285 |
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