The REFLO-STEMI trial comparing intracoronary adenosine, sodium nitroprusside and standard therapy for the attenuation of infarct size and microvascular obstruction during primary percutaneous coronary intervention: study protocol for a randomised contro

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• 作者：Sheraz A Nazir (5)
  Jamal N Khan (5)
  Islam Z Mahmoud (6)
  John P Greenwood (7)
  Daniel J Blackman (7)
  Vijay Kunadian (8)
  Martin Been (9)
  Keith R Abrams (10)
  Robert Wilcox (11)
  AA Jennifer Adgey (12)
  Gerry P McCann (5)
  Anthony H Gershlick (5)
  
  5. Department of Cardiovascular Sciences ; University of Leicester and the NIHR Leicester Cardiovascular Biomedical Research Unit ; Glenfield Hospital ; Groby Road ; LE3 9QP ; Leicester ; UK
  6. Department of Cardiovascular Imaging ; Division of Imaging Sciences & Biomedical Engineering ; Rayne Institute ; BHF Excellence Centre ; St Thomas鈥?Hospital ; King鈥檚 College London ; London ; UK
  7. Multidisciplinary Cardiovascular Research Centre ; Leeds Institute of Genetics ; Health and Therapeutics ; University of Leeds ; Leeds ; UK
  8. Institute of Cellular Medicine ; Faculty of Medical Sciences ; Newcastle University and Cardiothoracic Centre ; Freeman Hospital ; Newcastle upon Tyne Hospitals NHS Foundation Trust ; Newcastle upon Tyne ; UK
  9. Department of Cardiology ; University Hospitals Coventry and Warwickshire NHS Trust ; Coventry ; UK
  10. Centre for Biostatistics & Genetic Epidemiology ; Department of Health Sciences ; School of Medicine ; University of Leicester ; Leicester ; UK
  11. Faculty of Medicine & Health Sciences ; Queen鈥檚 Medical Centre ; Nottingham ; UK
  12. Heart Centre ; Royal Victoria Hospital ; Belfast ; Northern Ireland ; UK
  
• 关键词：Cardiovascular magnetic resonance ; Myocardial infarction ; Microvascular obstruction ; Adenosine ; Nitroprusside ; Primary angioplasty
• 刊名：Trials
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：15
• 期：1
• 全文大小：1,216 KB
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• 刊物主题：Medicine/Public Health, general; Biomedicine general; Statistics for Life Sciences, Medicine, Health Sciences;
• 出版者：BioMed Central
• ISSN：1745-6215

文摘

Background Microvascular obstruction (MVO) secondary to ischaemic-reperfusion injury is an important but underappreciated determinant of short- and longer-term outcome following percutaneous coronary intervention (PCI) treatment of ST-elevation myocardial infarction (STEMI). Several small studies have demonstrated a reduction in the degree of MVO utilising a variety of vasoactive agents, with adenosine and sodium nitroprusside (SNP) being most evaluated. However, the evidence base remains weak as the trials have had variable endpoints, differing drug doses and delivery. As such, the results regarding benefit are conflicting. Methods The REperfusion Facilitated by LOcal adjunctive therapy in STEMI (REFLO-STEMI) trial is a multicentre, prospective, randomised, controlled, open label, study with blinded endpoint analysis: Patients presenting within 6 h of onset of STEMI and undergoing planned primary PCI (P-PCI) with TIMI 0/1 flow in the infarct-related artery (IRA) and no significant bystander coronary artery disease on angiography, are randomised into one of three groups: PCI with adjunctive pharmacotherapy (intracoronary adenosine or SNP) or control (standard PCI). All receive Bivalirudin anticoagulation and thrombus aspiration. The primary outcome is infarct size (IS) (determined as a percentage of total left ventricular mass) measured by cardiac magnetic resonance imaging (CMRI) undertaken at 48 to 72 h post P-PCI. Secondary outcome measures include MVO (hypoenhancement within infarct core) on CMRI, angiographic markers of microvascular perfusion and MACE during 1-month follow-up. The study aims to recruit 240 patients (powered at 80% to detect a 5% absolute reduction in IS). Discussion The REFLO-STEMI study has been designed to address the weaknesses of previous trials, which have collectively failed to demonstrate whether adjunctive pharmacotherapy with adenosine and/or SNP can reduce measures of myocardial injury (infarct size and MVO) and improve clinical outcome, despite good basic evidence that they have the potential to attenuate this process. The REFLO-STEMI study will be the most scientifically robust trial to date evaluating whether adjunctive therapy (intracoronary adenosine or SNP following thrombus aspiration) reduces CMRI measured IS and MVO in patients undergoing P-PCI within 6 h of onset of STEMI. Trial registration Trial registered 20th November 2012: ClinicalTrials.gov Identifier NCT01747174.