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
TLDR
The intracoronary administration of anisodamine appears to improve myocardial reperfusion, cardiac function, and clinical outcomes in patients with STEMI undergoing PPCI.Abstract:
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. 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. 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. 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.read more
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2019 Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology Guidelines on the Acute Management of ST-Elevation Myocardial Infarction: Focused Update on Regionalization and Reperfusion.
Graham C. Wong,Michelle Welsford,Craig Ainsworth,Wael Abuzeid,Christopher B. Fordyce,Jennifer Greene,Thao Huynh,Laurie J. Lambert,Michel R. Le May,Sohrab Lutchmedial,Shamir R. Mehta,Madhu K. Natarajan,Colleen M. Norris,Christopher B. Overgaard,Michele Perry Arnesen,Ata ur Rehman Quraishi,Jean Francois Tanguay,Mouheiddin Traboulsi,Sean van Diepen,Robert C. Welsh,David A. Wood,Warren J. Cantor,Paul W. Armstrong,Akshay Bagai,Kevin R. Bainey,John A. Cairns,Sheldon Cheskes,John Ducas,V. Dzavik,Sanjit S. Jolly,Jennifer McVey,Erick Schampaert,Gregory Schnell,Derek So +33 more
TL;DR: The Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology STEMI guideline was developed to provide advice regarding the optimal acute management of STEMI patients irrespective of where they are initially identified, and it is anticipated that these guidelines will serve as a practical template to develop systems of care capable of providing optimal treatment for a wide range ofSTEMI patients.
Journal ArticleDOI
CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) in 2018
Yukio Ozaki,Yuki Katagiri,Yoshinobu Onuma,Yoshinobu Onuma,Tetsuya Amano,Takashi Muramatsu,Ken Kozuma,Satoru Otsuji,Takafumi Ueno,Nobuo Shiode,Kazuya Kawai,Nobuhiro Tanaka,Kinzo Ueda,Takashi Akasaka,Keiichi Igarashi Hanaoka,Shiro Uemura,Hirotaka Oda,Yoshiaki Katahira,Kazushige Kadota,Eisho Kyo,Katsuhiko Sato,Tadaya Sato,Junya Shite,Koichi Nakao,Masami Nishino,Yutaka Hikichi,Junko Honye,Tetsuo Matsubara,Sumio Mizuno,Toshiya Muramatsu,Taku Inohara,Shun Kohsaka,Ichiro Michishita,Hiroyoshi Yokoi,Patrick W. Serruys,Yuji Ikari,Masato Nakamura +36 more
TL;DR: The Task Force on Primary Percutaneous Coronary Intervention of the Japanese Association of Cardiovascular Intervention and Therapeutics has now proposed the expert consensus document for the management of acute myocardial infarction focusing on procedural aspect of primary PCI.
Journal ArticleDOI
CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) update 2022
Yukio Ozaki,Hironori Hara,Yoshinobu Onuma,Yuki Katagiri,Tetsuya Amano,Yoshio Kobayashi,Takashi Muramatsu,Hideki Ishii,Ken Kozuma,Nobuhiro Tanaka,Hiroshi Matsuo,Shiro Uemura,Kazushige Kadota,Yutaka Hikichi,Kenichi Tsujita,Junya Ako,Yoshihisa Nakagawa,Yoshihiro Morino,Ichiro Hamanaka,Nobuo Shiode,Junya Shite,Junko Honye,Tetsuo Matsubara,Kazuya Kawai,Yasumi Igarashi,Atsunori Okamura,Takayuki Ogawa,Yoshisato Shibata,Takafumi Tsuji,Junji Yajima,Kaoru Iwabuchi,Nobuo Komatsu,Teruyasu Sugano,Masaru Yamaki,Shinichiro Yamada,Hiroaki Hirase,Yuusuke Miyashita,Fuminobu Yoshimachi,Masakazu Kobayashi,Jiro Aoki,Hirotaka Oda,Yoshiaki Katahira,Kinzo Ueda,Masami Nishino,Koichi Nakao,Ichiro Michishita,Takafumi Ueno,Taku Inohara,Shun Kohsaka,Tevfik F Ismail,Patrick W. Serruys,Masato Nakamura,Hiroyoshi Yokoi,Yuji Ikari +53 more
TL;DR: In this article , the authors proposed an expert consensus document for the management of acute myocardial infarction (AMI) focusing on procedural aspects of primary PCI in 2018 and 2019.
Journal ArticleDOI
Genome-wide association and multi-omic analyses reveal ACTN2 as a gene linked to heart failure.
Marios Arvanitis,Emmanouil Tampakakis,Yanxiao Zhang,Wei Wang,Adam Auton,Diptavo Dutta,Stephanie Glavaris,Ali R. Keramati,Nilanjan Chatterjee,Neil C. Chi,Bing Ren,Bing Ren,Wendy S. Post,Alexis Battle +13 more
TL;DR: A large scale meta-analysis of heart failure GWAS and replication in a comparable sized cohort to identify one known and two novel loci associated with heart failure reveal a putative causal variant in a cardiac muscle specific regulatory region activated during cardiomyocyte differentiation that binds to the ACTN2 gene.
Journal ArticleDOI
Systematic Incorporation of Sex-Specific Information Into Clinical Practice Guidelines for the Management of ST -Segment-Elevation Myocardial Infarction: Feasibility and Outcomes.
Colleen M. Norris,Colleen M. Norris,Cara Tannenbaum,Louise Pilote,Graham C. Wong,Warren J. Cantor,Micheal Sean McMurtry +6 more
TL;DR: Inadequate enrollment and reporting by sex hindered comprehensive sex‐specific assessment of the quality of evidence and strength of recommendations for a CPG on the management of ST‐segment–elevation myocardial infarction.
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