scholarly journals Comparison of Intracoronary Epinephrine and Adenosine for No-Reflow in Normotensive Patients With Acute Coronary Syndrome (COAR Trial)

2022 ◽  
Author(s):  
Kamran Ahmed Khan ◽  
Nadeem Qamar ◽  
Tahir Saghir ◽  
Jawaid Akbar Sial ◽  
Dileep Kumar ◽  
...  
Keyword(s):  
Major Adverse Cardiac Events ◽  
Cardiac Events ◽  
Short Term ◽  
End Points ◽  
Timi Frame Count ◽  
No Reflow ◽  
Adverse Cardiac Events ◽  
Corrected Timi Frame Count ◽  
Short Term Mortality ◽  
Grade Iii

Background: Intracoronary epinephrine has been effectively used in treating refractory no-reflow, but there is a dearth of data on its use as a first-line drug in normotensive patients in comparison to the widely used adenosine. Methods: In this open-labeled randomized clinical trial, 201 patients with no-reflow were randomized 1:1 into intracoronary epinephrine as the treatment group and intracoronary adenosine as the control group and followed for 1 month. The primary end points were improvement in coronary flow, as assessed by TIMI (Thrombolysis in Myocardial Infarction) flow, frame counts, and myocardial blush. Secondary end points were in-hospital and short-term mortality and major adverse cardiac events. Results: In all, 101 patients received intracoronary epinephrine and 100 patients received adenosine. Epinephrine was generally well tolerated with no immediate table death or ventricular fibrillation. No-reflow was more effectively improved with epinephrine with final TIMI III flow (90.1% versus 78%, P =0.019) and final corrected TIMI frame count (24±8.43 versus 26.63±9.22, P =0.036). However, no significant difference was observed in final grade III myocardial blush (55.4% versus 45%, P =0.139), mean reduction of corrected TIMI frame count (−25.71±11.79 versus −26.08±11.71, P =0.825), in-hospital and short-term mortality, and major adverse cardiac events. Conclusions: Epinephrine is relatively safe to use in no-reflow in normotensive patients. A significantly higher frequency of post-treatment TIMI III flow grade and lower final corrected TIMI frame count with relatively better achievement of myocardial blush grade III translate into it displaying relatively better efficacy than adenosine. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04699110.

scholarly journals Prognostic Value of Systemic Immune-Inflammation Index for Major Adverse Cardiac Events and Mortality in Severe Aortic Stenosis Patients after TAVI

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 588
Author(s):  
Aydin Rodi Tosu ◽  
Muhsin Kalyoncuoglu ◽  
Halil İbrahim Biter ◽  
Sinem Cakal ◽  
Murat Selcuk ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Prognostic Value ◽  
Major Adverse Cardiac Events ◽  
Cardiac Events ◽  
Short Term ◽  
Cox Regression Analysis ◽  
Adverse Cardiac Events ◽  
All Cause Mortality ◽  
Auc Value ◽  
Immune Inflammation

Background and objectives: In this study, we aimed to evaluate whether the systemic immune-inflammation index (SII) has a prognostic value for major adverse cardiac events (MACEs), including stroke, re-hospitalization, and short-term all-cause mortality at 6 months, in aortic stenosis (AS) patients who underwent transcatheter aortic valve implantation (TAVI). Materials and Methods: A total of 120 patients who underwent TAVI due to severe AS were retrospectively included in our study. The main outcome of the study was MACEs and short-term all-cause mortality at 6 months. Results: The SII was found to be higher in TAVI patients who developed MACEs than in those who did not develop them. Multivariate Cox regression analysis revealed that the SII (HR: 1.002, 95%CI: 1.001–1.003, p < 0.01) was an independent predictor of MACEs in AS patients after TAVI. The optimal value of the SII for MACEs in AS patients following TAVI was >1.056 with 94% sensitivity and 96% specificity (AUC (the area under the curve): 0.960, p < 0.01). We noted that the AUC value of SII in predicting MACEs was significantly higher than the AUC value of the C-reactive protein (AUC: 0.960 vs. AUC: 0.714, respectively). Conclusions: This is the first study to show that high pre-procedural SII may have a predictive value for MACEs and short-term mortality in AS patients undergoing TAVI.

scholarly journals Clinical outcomes of nicorandil administration in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: a systematic review and meta-analysis of randomized controlled trials

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ning Geng ◽  
Li Ren ◽  
Lisheng Xu ◽  
Deling Zou ◽  
Wenyue Pang
Keyword(s):  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Major Adverse Cardiac Events ◽  
Controlled Trials ◽  
Cardiac Events ◽  
St Segment Elevation ◽  
No Reflow ◽  
St Segment ◽  
Adverse Cardiac Events ◽  
No Reflow Phenomenon

Abstract Background Primary percutaneous coronary intervention is the treatment of choice in ST-segment elevation myocardial infarction and no-reflow phenomenon is still an unsolved problem. Methods We searched PubMed, EmBase, and Cochrane Central Register of Controlled Trials for relevant randomized controlled trials. The primary endpoint was the incidence of major adverse cardiac events and the secondary endpoint was the incidences of no-reflow phenomenon and complete resolution of ST-segment elevation. Results Eighteen randomized controlled trials were enrolled. Nicorandil significantly reduced the incidence of no-reflow phenomenon (OR, 0.46; 95% CI, 0.36–0.59; P < 0.001; I2 = 0%) and major adverse cardiac events (OR, 0.42; 95% CI, 0.27–0.64; P < 0.001; I2 = 52%). For every single outcome of major adverse cardiac events, only heart failure and ventricular arrhythmia were significantly improved with no heterogeneity (OR, 0.36; 95% CI, 0.23–0.57, P < 0.001; OR, 0.43; 95% CI, 0.31–0.60, P < 0.001 respectively). A combination of intracoronary and intravenous nicorandil administration significantly reduced the incidence of major adverse cardiac events with no heterogeneity (OR, 0.24; 95% CI, 0.13–0.43, P < 0.001; I2 = 0%), while a single intravenous administration could not (OR, 0.66; 95% CI, 0.40–1.06, P = 0.09; I2 = 52%). Conclusions Nicorandil can significantly improve no-reflow phenomenon and major adverse cardiac events in patients undergoing primary percutaneous coronary intervention. The beneficial effects on major adverse cardiac events might be driven by the improvements of heart failure and ventricular arrhythmia. A combination of intracoronary and intravenous administration might be an optimal usage of nicorandil.

scholarly journals Short-Term Effects of Verapamil and Diltiazem in the Treatment of No Reflow Phenomenon: A Meta-Analysis of Randomized Controlled Trials

2015 ◽  
Vol 2015 ◽  
pp. 1-7
Author(s):  
Lan Wang ◽  
Zhong Cheng ◽  
Ye Gu ◽  
Dingfeng Peng
Keyword(s):  
Meta Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cardiac Events ◽  
Ventricular Ejection Fraction ◽  
Timi Frame Count ◽  
No Reflow ◽  
Adverse Cardiac Events ◽  
No Reflow Phenomenon ◽  
And Control

Currently, there is still a lack of an optimal treatment for no reflow phenomenon (NRP). We analyzed the efficacy and safety of using nondihydropyridine calcium channel antagonists (NDHP, verapamil/diltiazem) in patients suffering from NRP. Eight RCTs with 494 participants were eligible for analysis. The pooling analysis showed that intracoronary verapamil/diltiazem injection significantly decreased the occurrence of the coronary NRP (RR: 0.3, 95% CI: 0.16–0.57;P=0.0002) and reduced corrected thrombolysis in myocardial infarction (TIMI) frame Count (WMD = −9.24, 95% CI −13.91–4.57;P=0.0001) in patients with NRP. Moreover, verapamil/diltiazem treatment showed superiority in reducing wall motion index (WMI) compared to the control at day 1 (WMD = 0.11, 95% CI: 0.02–0.20;P=0.02) (P<0.05). There was also a significantly greater decline at occurrence of the major adverse cardiac events between verapamil/diltiazem and control groups (WMD: 0.4, 95% CI: 0.19–0.84;P=0.02). However, using verapamil/diltiazem did not provide additional improvement of left ventricular ejection fraction post procedure (at 7 days, WMD, 0.1; 95% CI, −2.43–2.63;P=0.94; at 30 days, WMD, 0.42; 95% CI, −2.09–2.92;P=0.75). NDHP use is beneficial in attenuating NRP and reducing 6-month MACEs in patients with NRP.

Leptin predicts short-term major adverse cardiac events in patients with coronary artery disease

2017 ◽  
Vol 49 (5) ◽  
pp. 448-454 ◽  
Author(s):  
Veli-Pekka Puurunen ◽  
Antti Kiviniemi ◽  
Samuli Lepojärvi ◽  
Olli-Pekka Piira ◽  
Pirjo Hedberg ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Major Adverse Cardiac Events ◽  
Cardiac Events ◽  
Short Term ◽  
Adverse Cardiac Events ◽  
Artery Disease

scholarly journals Clinical Outcomes of Nicorandil Administration In Patients With Acute ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: A Systematic Review And Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Author(s):  
Ning Geng ◽  
Li Ren ◽  
Lisheng Xu ◽  
Deling Zou ◽  
Wenyue Pang
Keyword(s):  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Major Adverse Cardiac Events ◽  
Controlled Trials ◽  
Cardiac Events ◽  
St Segment Elevation ◽  
No Reflow ◽  
St Segment ◽  
Adverse Cardiac Events ◽  
No Reflow Phenomenon

Abstract Background: Primary percutaneous coronary intervention is the treatment of choice in ST-segment elevation myocardial infarction and no-reflow phenomenon is still an unsolved problem.Methods: We searched PubMed, EmBase, and Cochrane Central Register of Controlled Trials for relevant randomized controlled trials. The primary endpoint was the incidence of major adverse cardiac events and the secondary endpoint was the incidences of no-reflow phenomenon and complete resolution of ST-segment elevation. Results: Eighteen randomized controlled trials were enrolled. Nicorandil significantly reduced the incidence of no-reflow phenomenon (OR, 0.46; 95% CI, 0.36 to 0.59; P＜0.001; I2=0%) and major adverse cardiac events (OR, 0.42; 95% CI, 0.27 to 0.64; P＜0.001; I2=52%). For every single outcome of major adverse cardiac events, only heart failure and ventricular arrhythmia were significantly improved with no heterogeneity (OR, 0.36; 95% CI, 0.23 to 0.57, P＜0.001; OR, 0.43; 95% CI, 0.31 to 0.60, P＜0.001 respectively). A combination of intracoronary and intravenous nicorandil administration significantly reduced the incidence of major adverse cardiac events with no heterogeneity (OR, 0.24; 95% CI, 0.13 to 0.43, p＜0.001), while a single intravenous administration could not (OR, 0.66; 95% CI, 0.40 to 1.06, p=0.09; I2=52%). Conclusions: Nicorandil can significantly improve no-reflow phenomenon and major adverse cardiac events in patients undergoing primary percutaneous coronary intervention. The beneficial effects on major adverse cardiac events might be driven by the improvements of heart failure and ventricular arrhythmia. A combination of intracoronary and intravenous administration might be an optimal usage of nicorandil.

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