Comparison between The Efficacy of Intracoronary Nitroglycerin versus Nitroglycerin Plus Glycoprotein Inhibitors for Treatment of Patients with Thrombolysis in Myocardial Infarction Flow Less Than Three during Primary Percutaneous Coronary Intervention

Abstract

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.