Key result
Intracoronary nitroglycerin plus GP IIb/IIIa inhibitors improved angiographic outcomes (TIMI 3 and MBG ≥2) compared to nitroglycerin alone during PPCI for STEMI (73.3% vs 40.0%; P=0.036).
Why the study?
The study evaluated the efficacy of intracoronary nitroglycerin versus nitroglycerin plus glycoprotein IIb/IIIa inhibitors for treating TIMI flow less than 3 during primary percutaneous coronary intervention in STEMI patients.
Does intracoronary nitroglycerin plus glycoprotein IIb/IIIa inhibitors improve angiographic outcomes and reduce MACE in STEMI patients with TIMI flow < 3 during primary PCI compared to nitroglycerin alone?
RCT (n=30)
randomized
Does intracoronary nitroglycerin plus glycoprotein IIb/IIIa inhibitors improve angiographic outcomes and reduce MACE in STEMI patients with TIMI flow < 3 during primary PCI compared to nitroglycerin alone?
The addition of intracoronary glycoprotein IIb/IIIa inhibitors to nitroglycerin during primary PCI for STEMI significantly improves angiographic flow and reduces 30-day MACE compared to nitroglycerin alone.
Supports adjunctive GP IIb/IIIa with IC nitroglycerin in STEMI PPCI; extends small RCT evidence for angiographic benefit.
Background: Primary percutaneous coronary intervention (PPCI) is currently the cornerstone of management in patients with ST-segment elevation myocardial infarction (STEMI). Aim of the work: comparison between the efficacies of intracoronary nitroglycerin (NTG) versus nitroglycerin plus glycoprotein inhibitors (GP) IIb/IIIa for treatment of patients with thrombolysis in myocardial infarction flow less than three during primary percutaneous coronary intervention. Patients and methods: we prospectively enrolled 30 patients with STEMI undergoing PPCI randomized to receive IC NTG only (n = 15) versus NTG plus GP IIb/IIIa inhibitors (n = 15) during PPCI. The primary outcome was the incidence of angiographic MVO as defined by thrombolysis in myocardial infarction flow less than 3 or thrombolysis in myocardial infarction flow 3 with myocardial blush grade less than 2. Results: NTG plus GP IIb/IIIa inhibitors were associated with better primary outcome compared to NTG only TIMI 3 & MBG > = 2 (40%vs 73.3%, respectively; P = 0.036). There was a trend towards improved left ventricular ejection fraction with NTG plus GP IIb/IIIa inhibitors (44.33 ± 9.76 vs 52.87 ± 11.23, respectively; P = 0.035). In addition, NTG plus GP IIb/IIIa inhibitors was associated with lower incidence of 30-day major adverse cardiovascular events (26.7 vs. 66.7% respectively; P = 0.028). Conclusion: In PPCI, NTG plus GP IIb/IIIa inhibitors resulted in significant improvements in no-reflow and MVO with a better safety profile compared to NTG only. Larger trials should be conducted to confirm these results.
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Motaweh et al. (2019) conducted an RCT in ST-segment elevation myocardial infarction (STEMI) (n=30). Intracoronary nitroglycerin plus glycoprotein IIb/IIIa inhibitors vs. Intracoronary nitroglycerin only was evaluated on Incidence of angiographic MVO as defined by thrombolysis in myocardial infarction flow less than 3 or thrombolysis in myocardial infarction flow 3 with myocardial blush grade less than 2 (p=0.036). Intracoronary nitroglycerin plus GP IIb/IIIa inhibitors improved angiographic outcomes (TIMI 3 and MBG ≥2) compared to nitroglycerin alone during PPCI for STEMI (73.3% vs 40.0%; P=0.036).
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