Savremeni pristup u prevenciji i terapiji no-reflow fenomena
Ključne reči:
no-reflow; akutni infarkt miokarda; ST elevacija; primarna perkutana koronarna intervencija; reperfuzija.
Sažetak
No-reflow fenomen je definisan kao stanje neadekvatne (nekompletne) perfuzije miokarda kroz određeni segment koronarne cirkulacije, u odsustvu mehaničke opstrukcije epikardne koronarne arterije, odnosno bez prisustva značajne rezidualne stenoze, spazma, okluzivne disekcije ili intrakoronarne tromboze. Razvoj no-reflow fenomena kod bolesnika sa akutnim infarktom miokarda sa ST elevacijom višestruko povećava rizik od ranih kliničkih komplikacija i mortaliteta. Rane intrahospitalne komplikacije se manifestuju u vidu hemodinamske nestabilnosti, akutne srčane insuficijencije uključujući i kardiogeni šok, rupture miokarda, a nastaju kao posledica ekstenzije područja miokardne nekroze, malignih srčanih aritmija, poremećaja u sprovođenju i akutnog edema pluća. Cilj ovog preglednog rada je da se prikažu savremeni aspekti prevencije i terapijskih mogućnosti kod bolesnika sa razvijenim no-reflow fenomenom. Prevencija podrazumeva primenu različitih strategija pre kompletnog ponovnog otvaranja okludirane infarktne koronarne arterije, s ciljem pripreme koronarne mikrocirkulacije za reperfuziju. Preventivne mere bi trebalo da budu usmerene prema različitim patofiziološkim mehanizmima nastanka no-reflow fenomena da bi bile efikasne, od redukcije ukupnog ishemijskog vremena, do primene različitih farmakoloških i nefarmakoloških mera. Primena terapijskih mera je pak potrebna u slučaju neuspešne prevencije i razvoja no-reflow fenomena. U ovom kontekstu terapijski agensi treba da budu efikasni tokom aktuelnog i progresivnog oštećenja miokardne cirkulacije, a savremena metoda primarne perkutane koronarne intervencije pruža mogućnosti isporučivanja visokih lokalnih doza farmakoloških agenasa direktno u infarktnu koronarnu arteriju, za razliku od tradicionalnog lečenja primenom fibrinolitičke terapije.
Reference
1.Ееckhout E, Kern MJ. The coronary no-reflow phenomenon: a review of mechanisms and therapies. Eur Heart J 2021; 22: 729-39.
2.Ooi E, Tavella R, Arstall M, et al. Incidence and outcomes of the no-reflow phenomenon during percutaneous coronary intervention: Insights from the CADOSA registry. Heart, Lung and Circulation. 2015; 24; S279.
3.Choo EH, Kim PJ, Chang K, et al. The impact of no-reflow phenomena after primary percutaneous coronary intervention: a time-dependent analysis of mortality. Coron Artery Dis. 2014; 25: 392-8.
4.Bøtker HE, Kharbanda R, Schmidt MR, et al. Remote ischaemic conditioning before hospital admission, as a complement to angioplasty, and effect on myocardial salvage in patients with acute myocardial infarction: a randomised trial. Lancet. 2010; 375: 727-34.
5.Ibanez B, James S, Agewall S, et al. ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018; 39: 119-77.
6.Marzilli M, Orsini E, Marraccini P, Testa R. Beneficial effects of intracoronary adenosine as an adjunct to primary angioplasty in acute myocardial infarction. Circulation. 2000; 101: 2154-9.
7.Sadeghian M, Mousavi SH, Aamaraee Z, Shafiee A. Administration of intracoronary adenosine before stenting for the prevention of no-reflow in patients with ST-elevation myocardial infarction. Scand Cardiovasc J. 2022; 56: 23-7.
8.Kostic J, Djordjevic-Dikic A, Dobric M, et al. The effects of nicorandil on microvascular function in patients with ST segment elevation myocardial infarction undergoing primary PCI. Cardiovasc Ultrasound. 2015;13:26.
9.Geng N, Ren L, Xu L, Zou D, Pang W. 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. BMC Cardiovasc Disord. 2021; 21: 488.
10.Amit G, Cafri C, Yaroslavtsev S, et al. Intracoronary nitroprusside for the prevention of the no-reflow phenomenon after primary percutaneous coronary intervention in acute myocardial infarction. A randomized, double-blind, placebo-controlled clinical trial. Am Heart J. 2006; 152: 887.e9-14.
11.Zhao YJ, Fu XH, Ma XX, et al. Intracoronary fixed dose of nitroprusside via thrombus aspiration catheter for the prevention of the no-reflow phenomenon following primary percutaneous coronary intervention in acute myocardial infarction. Exp Ther Med. 2013; 6: 479-4.
12.Jolly SS, James S, Džavík V, et al. Thrombus Aspiration in ST-Segment-Elevation Myocardial Infarction: An Individual Patient Meta-Analysis: Thrombectomy Trialists Collaboration. Circulation. 2017; 135: 143-52.
13.Carrick D, Oldroyd KG, McEntegart M, et al. A randomized trial of deferred stenting versus immediate stenting to prevent no- or slow-reflow in acute ST-segment elevation myocardial infarction (DEFER-STEMI). J Am Coll Cardiol. 2014; 63: 2088-98.
14.Kelbæk H, Høfsten DE, Køber L, et al. Deferred versus conventional stent implantation in patients with ST-segment elevation myocardial infarction (DANAMI 3-DEFER): an open-label, randomised controlled trial. Lancet. 2016; 387: 2199-206.
15.Cassese S, Belle L, Ndrepepa G, et al. Deferred vs Immediate Stenting in Primary Percutaneous Coronary Intervention: A Collaborative Meta-analysis of Randomized Trials With Cardiac Magnetic Resonance Imaging Data. Can J Cardiol. 2018; 34: 1573-80.
16.Desch S, Wöhrle J, Hambrecht R, et al. Intracoronary versus intravenous abciximab bolus in patients with ST-segment elevation myocardial infarction: 1-year results of the randomized AIDA STEMI trial. J Am Coll Cardiol. 2013; 62: 1214-5.
17.Alyamani M, Campbell S, Navarese E, Welsh RC, Bainey KR. Safety and Efficacy of Intracoronary Thrombolysis as Adjunctive Therapy to Primary PCI in STEMI: A Systematic Review and Meta-analysis. Can J Cardiol. 2021; 37:339-46.
18.Malmberg K, Rydén L, Efendic S, et al. Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study): effects on mortality at 1 year. J Am Coll Cardiol. 1995; 26: 57-65.
19.Iwakura K. Modulation of individual susceptibility to the no-reflow phenomenon after acute myocardial infarction. Curr Pharm Des. 2013; 19: 4519-28.
20.Atar D, Petzelbauer P, Schwitter J, et al. Effect of intravenous FX06 as an adjunct to primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction results of the F.I.R.E. (Efficacy of FX06 in the Prevention of Myocardial Reperfusion Injury) trial. J Am Coll Cardiol. 2009; 53: 720-9.
21.Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018; 39: 119-77.
22.Rezkalla SH, Stankowski RV, Hanna J, Kloner RA. Management of No-Reflow Phenomenon in the Catheterization Laboratory. JACC Cardiovasc Interv. 2017; 10: 215-23.
23.Kumar D, Ahmed I, Bardooli F, et al. Techniques to Treat Slow-Flow/No-Reflow During Primary Percutaneous Coronary Intervention. Cardiovasc Revasc Med. 2023; 47: 1-4.
24.Sinha SK, Kumar P, Sharma AK, et al. Perforated balloon technique mediated intracoronary delivery of nicorandil to treat coronary no-reflow phenomenon: a novel pharmacological solution to precarious situation. Am J Cardiovasc Dis. 2021; 11: 544-54.
25.Xu L, Wang L, Li K, et al. Nicorandil prior to primary percutaneous coronary intervention improves clinical outcomes in patients with acute myocardial infarction: a meta-analysis of randomized controlled trials. Drug Des Devel Ther. 2019; 13: 1389-1400.
26.Navarese EP, Frediani L, Kandzari DE, et al. Efficacy and safety of intracoronary epinephrine versus conventional treatments alone in STEMI patients with refractory coronary no-reflow during primary PCI: The RESTORE observational study. Catheter Cardiovasc Interv. 2021; 97: 602-11.
27.Darwish A, Frere AF, Abdelsamie M, Awady WE, Gouda M. Intracoronary epinephrine versus adenosine in the management of refractory no-reflow phenomenon: a single-center retrospective cohort study. Ann Saudi Med. 2022; 42: 75-82.
28.Grancini L, Diana D, Centola A, et al. The SALINE Technique for the Treatment of the No-Reflow Phenomenon during Percutaneous Coronary Intervention in STEMI. Journal of Clinical Medicine. 2023; 12: 2405.
29.Nazir SA, Khan JN, Mahmoud IZ, et al. The REFLO-STEMI (REperfusion Facilitated by LOcal adjunctive therapy in ST-Elevation Myocardial Infarction) trial: a randomised controlled trial comparing intracoronary administration of adenosine or sodium nitroprusside with control for attenuation of microvascular obstruction during primary percutaneous coronary intervention. Southampton (UK): NIHR Journals Library; 2016 Dec. PMID: 27929619.
30.Annibali G, Scrocca I, Aranzulla TC, Meliga E, Maiellaro F, Musumeci G. “No-Reflow” Phenomenon: A Contemporary Review. J Clin Med 2022, 11, 2233.
2.Ooi E, Tavella R, Arstall M, et al. Incidence and outcomes of the no-reflow phenomenon during percutaneous coronary intervention: Insights from the CADOSA registry. Heart, Lung and Circulation. 2015; 24; S279.
3.Choo EH, Kim PJ, Chang K, et al. The impact of no-reflow phenomena after primary percutaneous coronary intervention: a time-dependent analysis of mortality. Coron Artery Dis. 2014; 25: 392-8.
4.Bøtker HE, Kharbanda R, Schmidt MR, et al. Remote ischaemic conditioning before hospital admission, as a complement to angioplasty, and effect on myocardial salvage in patients with acute myocardial infarction: a randomised trial. Lancet. 2010; 375: 727-34.
5.Ibanez B, James S, Agewall S, et al. ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018; 39: 119-77.
6.Marzilli M, Orsini E, Marraccini P, Testa R. Beneficial effects of intracoronary adenosine as an adjunct to primary angioplasty in acute myocardial infarction. Circulation. 2000; 101: 2154-9.
7.Sadeghian M, Mousavi SH, Aamaraee Z, Shafiee A. Administration of intracoronary adenosine before stenting for the prevention of no-reflow in patients with ST-elevation myocardial infarction. Scand Cardiovasc J. 2022; 56: 23-7.
8.Kostic J, Djordjevic-Dikic A, Dobric M, et al. The effects of nicorandil on microvascular function in patients with ST segment elevation myocardial infarction undergoing primary PCI. Cardiovasc Ultrasound. 2015;13:26.
9.Geng N, Ren L, Xu L, Zou D, Pang W. 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. BMC Cardiovasc Disord. 2021; 21: 488.
10.Amit G, Cafri C, Yaroslavtsev S, et al. Intracoronary nitroprusside for the prevention of the no-reflow phenomenon after primary percutaneous coronary intervention in acute myocardial infarction. A randomized, double-blind, placebo-controlled clinical trial. Am Heart J. 2006; 152: 887.e9-14.
11.Zhao YJ, Fu XH, Ma XX, et al. Intracoronary fixed dose of nitroprusside via thrombus aspiration catheter for the prevention of the no-reflow phenomenon following primary percutaneous coronary intervention in acute myocardial infarction. Exp Ther Med. 2013; 6: 479-4.
12.Jolly SS, James S, Džavík V, et al. Thrombus Aspiration in ST-Segment-Elevation Myocardial Infarction: An Individual Patient Meta-Analysis: Thrombectomy Trialists Collaboration. Circulation. 2017; 135: 143-52.
13.Carrick D, Oldroyd KG, McEntegart M, et al. A randomized trial of deferred stenting versus immediate stenting to prevent no- or slow-reflow in acute ST-segment elevation myocardial infarction (DEFER-STEMI). J Am Coll Cardiol. 2014; 63: 2088-98.
14.Kelbæk H, Høfsten DE, Køber L, et al. Deferred versus conventional stent implantation in patients with ST-segment elevation myocardial infarction (DANAMI 3-DEFER): an open-label, randomised controlled trial. Lancet. 2016; 387: 2199-206.
15.Cassese S, Belle L, Ndrepepa G, et al. Deferred vs Immediate Stenting in Primary Percutaneous Coronary Intervention: A Collaborative Meta-analysis of Randomized Trials With Cardiac Magnetic Resonance Imaging Data. Can J Cardiol. 2018; 34: 1573-80.
16.Desch S, Wöhrle J, Hambrecht R, et al. Intracoronary versus intravenous abciximab bolus in patients with ST-segment elevation myocardial infarction: 1-year results of the randomized AIDA STEMI trial. J Am Coll Cardiol. 2013; 62: 1214-5.
17.Alyamani M, Campbell S, Navarese E, Welsh RC, Bainey KR. Safety and Efficacy of Intracoronary Thrombolysis as Adjunctive Therapy to Primary PCI in STEMI: A Systematic Review and Meta-analysis. Can J Cardiol. 2021; 37:339-46.
18.Malmberg K, Rydén L, Efendic S, et al. Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study): effects on mortality at 1 year. J Am Coll Cardiol. 1995; 26: 57-65.
19.Iwakura K. Modulation of individual susceptibility to the no-reflow phenomenon after acute myocardial infarction. Curr Pharm Des. 2013; 19: 4519-28.
20.Atar D, Petzelbauer P, Schwitter J, et al. Effect of intravenous FX06 as an adjunct to primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction results of the F.I.R.E. (Efficacy of FX06 in the Prevention of Myocardial Reperfusion Injury) trial. J Am Coll Cardiol. 2009; 53: 720-9.
21.Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018; 39: 119-77.
22.Rezkalla SH, Stankowski RV, Hanna J, Kloner RA. Management of No-Reflow Phenomenon in the Catheterization Laboratory. JACC Cardiovasc Interv. 2017; 10: 215-23.
23.Kumar D, Ahmed I, Bardooli F, et al. Techniques to Treat Slow-Flow/No-Reflow During Primary Percutaneous Coronary Intervention. Cardiovasc Revasc Med. 2023; 47: 1-4.
24.Sinha SK, Kumar P, Sharma AK, et al. Perforated balloon technique mediated intracoronary delivery of nicorandil to treat coronary no-reflow phenomenon: a novel pharmacological solution to precarious situation. Am J Cardiovasc Dis. 2021; 11: 544-54.
25.Xu L, Wang L, Li K, et al. Nicorandil prior to primary percutaneous coronary intervention improves clinical outcomes in patients with acute myocardial infarction: a meta-analysis of randomized controlled trials. Drug Des Devel Ther. 2019; 13: 1389-1400.
26.Navarese EP, Frediani L, Kandzari DE, et al. Efficacy and safety of intracoronary epinephrine versus conventional treatments alone in STEMI patients with refractory coronary no-reflow during primary PCI: The RESTORE observational study. Catheter Cardiovasc Interv. 2021; 97: 602-11.
27.Darwish A, Frere AF, Abdelsamie M, Awady WE, Gouda M. Intracoronary epinephrine versus adenosine in the management of refractory no-reflow phenomenon: a single-center retrospective cohort study. Ann Saudi Med. 2022; 42: 75-82.
28.Grancini L, Diana D, Centola A, et al. The SALINE Technique for the Treatment of the No-Reflow Phenomenon during Percutaneous Coronary Intervention in STEMI. Journal of Clinical Medicine. 2023; 12: 2405.
29.Nazir SA, Khan JN, Mahmoud IZ, et al. The REFLO-STEMI (REperfusion Facilitated by LOcal adjunctive therapy in ST-Elevation Myocardial Infarction) trial: a randomised controlled trial comparing intracoronary administration of adenosine or sodium nitroprusside with control for attenuation of microvascular obstruction during primary percutaneous coronary intervention. Southampton (UK): NIHR Journals Library; 2016 Dec. PMID: 27929619.
30.Annibali G, Scrocca I, Aranzulla TC, Meliga E, Maiellaro F, Musumeci G. “No-Reflow” Phenomenon: A Contemporary Review. J Clin Med 2022, 11, 2233.
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2025/03/28
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