文献类型：期刊文献

英文题名：Effect of intracoronary agents on the no-reflow phenomenon during primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction: a network meta-analysis

作者：Niu, Xiaowei[1];Zhang, Jingjing[2];Bai, Ming[3];Peng, Yu[3];Sun, Shaobo[4];Zhang, Zheng[3]

第一作者：Niu, Xiaowei

通信作者：Zhang, Z[1]

机构：[1]Lanzhou Univ, Sch Clin Med 1, Tianshui South Rd 222, Lanzhou 730000, Gansu, Peoples R China;[2]Baiyin Second Peoples Hosp, Gongyuan Rd 509, Baiyin 730900, Gansu, Peoples R China;[3]Lanzhou Univ, Hosp 1, Dept Cardiol, Donggang West Rd 1, Lanzhou 730000, Gansu, Peoples R China;[4]Gansu Univ Chinese Med, Key Lab Prevent & Treatment Chron Dis, Dingxi East Rd 35, Lanzhou 730000, Gansu, Peoples R China

第一机构：Lanzhou Univ, Sch Clin Med 1, Tianshui South Rd 222, Lanzhou 730000, Gansu, Peoples R China

通信机构：[1]corresponding author), Lanzhou Univ, Hosp 1, Dept Cardiol, Donggang West Rd 1, Lanzhou 730000, Gansu, Peoples R China.

年份：2018

卷号：18

期号：1

外文期刊名：BMC CARDIOVASCULAR DISORDERS

收录：;Scopus(收录号：2-s2.0-85040377619);WOS:【SCI-EXPANDED(收录号:WOS:000419967200001)】；

语种：英文

外文关键词：Percutaneous coronary intervention; No reflow phenomenon; Intracoronary; pharmacology; Meta-analysis

摘要：Background: Despite the restoration of epicardial flow after primary percutaneous coronary intervention (PPCI), myocardial reperfusion remains impaired in a significant proportion of patients. We performed a network meta-analysis to assess the effect of 7 intracoronary agents (adenosine, anisodamine, diltiazem, nicorandil, nitroprusside, urapidil, and verapamil) on the no-reflow phenomenon in patients with ST-elevation myocardial infarction (STEMI) undergoing PPCI. Methods: Database searches were conducted to identify randomized controlled trials (RCTs) comparing the 7 agents with each other or with standard PPCI. Outcome measures included thrombolysis in myocardial infarction flow grade (TFG), ST-segment resolution (STR), left ventricular ejection fraction (LVEF), major adverse cardiovascular events (MACEs), and adverse events. Results: Forty-one RCTs involving 4069 patients were analyzed. The addition of anisodamine to standard PPCI for STEMI was associated, with improved, post-procedural TFG, more occurrences of STR, and improvement of LVEF. The cardioprotective effect of anisodamine conferred a MACE-free survival benefit. Additionally, nitroprusside was regarded as efficient in improving coronary flow and clinical outcomes. Compared with standard care, adenosine, nicorandil, and verapamil improved coronary flow but had no corresponding benefits regarding cardiac function and clinical outcomes. The ranking probability for the 7 treatment drugs showed, that anisodamine consistently ranked the highest in efficacy outcomes (TFG < 3, STR, LVEF, and MACEs). No severe adverse events, such as hypotension and malignant arrhythmia, were observed in patients treated with anisodamine. Network meta-regression analysis showed that age, the time to reperfusion, and study follow-up did not affect the treatment effects. Conclusions: The intracoronary administration of anisodamine appears to improve myocardial reperfusion, cardiac function, and clinical outcomes in patients with STEMI undergoing PPCI. Given the limited quality and quantity of the included studies, more rigorous RCTs are needed to verify the role of this inexpensive and well-tolerated regimen.