Key result
Alpha lipoic acid cuts no-reflow ~92% vs standard care in STEMI patients undergoing primary PCI.
Why the study?
Post-PCI induced oxidative stress is linked to the no-reflow phenomenon and poor prognosis in STEMI patients undergoing PPCI.
Does alpha lipoic acid administration reduce the occurrence of no-reflow phenomenon and improve oxidative stress markers in STEMI patients undergoing primary PCI?
RCT (n=70)
Open-label
Computer software program
Yes
Does alpha lipoic acid administration reduce the occurrence of no-reflow phenomenon and improve oxidative stress markers in STEMI patients undergoing primary PCI?
Answers are grounded in this paper and cite their sources.
Alpha lipoic acid administration before and after primary PCI in STEMI patients significantly reduces the incidence of no-reflow and improves left ventricular ejection fraction.
Background Primary percutaneous coronary intervention (PPCI) is the treatment of choice for ST-segment-elevation myocardial infarction (STEMI). Post-PCI induced-oxidative stress, a complication of PCI, is linked to the no-reflow (NR) phenomenon and poor prognosis. A clinical trial involving 70 STEMI patients was conducted to evaluate the impact of alpha lipoic acid (ALA), an antioxidant and anti-inflammatory agent, on oxidative stress and NR. The participants were randomized to standard care (control group) or 600 mg IV infusion of ALA pre/peri PPCI then 600 mg orally once for 28 days plus standard care (ALA group). Outcomes included the degree of myocardial reperfusion by thrombolysis in myocardial infarction (TIMI) flow and myocardial blush grade (MBG), Aldehyde dehydrogenase 2 (ALDH2) and Paroxonase 1 (PON-1) levels, also left ventricular ejection fraction (LVEF), and major adverse cardiac events (MACE). Results TIMI flow grade-3 and MBG grade-3 were significantly higher in the ALA group versus controls (97.1% and 62.9%, respectively, P = 0.001, 82.9%, and 45.7%, respectively, P = 0.002). ALDH2 and PON-1 levels were significantly higher in ALA versus controls post-PPCI at all-time points (24 h and 7 days). The ALA group exhibited better LVEF at 7 and 28 days when compared to controls. Conclusion ALA supplementation decreased the occurrence of NR, reduced myocardial ischemia–reperfusion injury (IRI) post-PPCI, increased ALDH2, and PON-1 levels, and improved LVEF.
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Elsayed et al. (2025) conducted an RCT in ST-segment-elevation myocardial infarction (STEMI) (n=70). Alpha lipoic acid (ALA) vs. Standard care was evaluated on Occurrence of no-reflow (NR) phenomenon after PCI (p=0.001). Alpha lipoic acid administration significantly reduced the occurrence of the no-reflow phenomenon to 2.9% compared to 34.3% with standard care in STEMI patients undergoing primary PCI.
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