Role of routine vascular bed preparation in patients undergoing primary percutaneous coronary intervention

Abstract Introduction Primary percutaneous coronary intervention (PCI) is one of the most effective treatments for acute STEMI. The main goals are to restore epicardial infarct-related artery patency and achieve microvascular reperfusion as early as possible, thus limiting the extent of irreversibly injured (necrotic) myocardium.(1) However, despite the presence of normal epicardial flow, post-procedural microvascular obstruction (MVO) which substantially reduces the beneficial effects of PCI. It is caused by a combination of thrombus formation, endothelial dysfunction, inflammation, and ischemia-reperfusion injury. MVO has been associated with adverse prognosis, adverse LV remodeling and diminished recovery of LV function, independently of infarct size.(2)The no reflow phenomenon incidence appears to be highest in acute myocardial infarction patients who undergoes primary PCI. Currently, there is still a lack of an optimal treatment for no-reflow phenomenon. Prevention can be effective to reduce no-reflow occurrence. Intracoronary vasodilation prior to PCI especially perforated balloon technique can prevent the no-reflow phenomenon during primary PCI, particularly by improving distal coronary perfusion and allowing for targeted drug delivery. There is no standard guideline at present for the various methods of intracoronary therapies prior to primary PCI. Purpose To study the utility of routine vascular bed preparation in patients undergoing primary PCI & its efficacy in terms of TIMI flow grade (TFG), TIMI frame count (TFC), TMP grade(TMPG) & to note the in hospital and 30-day MACEs in patients undergoing primary PCI. Method Prospective Observational Randomized Comparative Single Blinded Study. Total 135 patients with STEMI were recruited. 45 patients in each group. Group A: -Intracoronary vasodilator (abciximab, adenosine, diltiazem, adrenaline, nitrate) via guiding catheter followed by primary PCI. Group B: - Perforated balloon technique mediated intracoronary delivery of vasodilator (abciximab, adenosine, diltiazem, adrenaline, nitrate) followed by primary PCI (as shown in figure 1) Group C: - Control group i.e. routine primary PCI. The data entry was done in the Microsoft EXCEL & final analysis was done with the use of SPSS software. Result The baseline characteristics were comparable among Group A, Group B and Group C. The distribution of TFG, TFC & TMPG before and after stenting has been shown in table 1, and these parameters were significantly improved post stenting in group A and B as compared to group C. The distribution of 30-day MACE & in hospital MACE was comparable among Group A, Group B and Group C (p value = 0.797 & 0.773 respectively). Conclusion No-reflow is not infrequent following PCI especially in setting of primary PCI. Distal drug delivery through perforated balloon technique is easy, reproducible, less time consuming and cost-effective technique to prevent no reflow.Perforated balloon technique TFG,TFC,TMPG before & after stenting