Abstract
BackgroundPrimary percutaneous coronary intervention (PPCI) is the standard procedure for reperfusion for ST-segment elevation myocardial infarction (STEMI), but the occurrence of the no-reflow phenomenon remains common and is associated with adverse outcomes.AimsThis study aimed to evaluate whether prolonged balloon inflation in stent deployment would lessen the occurrence of the no-reflow phenomenon in PPCI compared with conventional rapid inflation/deflation strategy.MethodsPatients were randomly assigned to either the prolonged balloon inflation in stent deployment group (PBSG) or conventional deployment strategy group (CDSG) in a 1:1 ratio. A subset of patients was included in the cardiac magnetic resonance (CMR) assessment.ResultsThrombolysis in MI (TIMI) flow grade 3 was found in 96.7% and 63.3% of the patients of the PBSG and CDSG, respectively (P = 0.005). The results of the PBSG and CDSG are respectively shown as follows: 0% versus 30% no-reflow or slow flow (P = 0.002); 90% versus 66.7% ST-segment resolution ≥ 50% (P = 0.028); 35.6 ± 14.5 frames versus 49.18 ± 25.2 frames on corrected TIMI frame count (P = 0.014); and 60% versus 20% myocardial blush grade 3 (P = 0.001). At 1 month, the major cardiovascular adverse event (cardiovascular mortality) rate was 3.3% in both groups; at 1 year, the rate was 3.3% and 6.7% for the PBSG and CDSG, respectively (P = 1.00). In the CMR subset of cases, the presence of microvascular obstruction (MVO) was detected in 6.7% and 50% of the patients in the PBSG and CDSG, respectively (P = 0.023).ConclusionIn our pilot trial, prolonged balloon inflation during stent deployment strategy in PPCI reduces the occurrence of the no-reflow phenomenon in patients with STEMI and improved the myocardial microcirculation perfusion (ClinicalTrials.gov number: NCT03199014; registered: 26/June/2017).
Highlights
Primary percutaneous coronary intervention (PPCI) is the standard procedure for reperfusion for STsegment elevation myocardial infarction (STEMI), but the occurrence of the no-reflow phenomenon remains com‐ mon and is associated with adverse outcomes
Background the use of primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) in China has increased in recent decades, the in-hospital mortality and long-term prognosis of patients has not significantly changed [1]
The pathophysiology of the no-reflow phenomenon is multifactorial, and it is referred to as microvascular obstruction (MVO), which includes injuries related to ischemia, reperfusion, endothelial cell edema, thrombus embolization, and embolization of atherosclerotic plaque fragments [6]
Summary
Primary percutaneous coronary intervention (PPCI) is the standard procedure for reperfusion for STsegment elevation myocardial infarction (STEMI), but the occurrence of the no-reflow phenomenon remains com‐ mon and is associated with adverse outcomes. The pathophysiology of the no-reflow phenomenon is multifactorial, and it is referred to as microvascular obstruction (MVO), which includes injuries related to ischemia, reperfusion, endothelial cell edema, thrombus embolization, and embolization of atherosclerotic plaque fragments [6]. These injuries are of concern during PPCI [7]. It is possible that the stent itself affixes the thrombus to the vessel wall, especially if the thrombus is more fibrous [9]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
