Evidence map›Paper›PMID 27147610›Full record

Trial reportEuropean heart journal2016

Strategies to attenuate micro-vascular obstruction during P-PCI: the randomized reperfusion facilitated by local adjunctive therapy in ST-elevation myocardial infarction trial.

Sheraz A Nazir, Gerry P McCann, John P Greenwood, Vijay Kunadian, Jamal N Khan, Islam Z Mahmoud, Daniel J Blackman, Martin Been, Keith R Abrams, Lorraine Shipley and 3 more

Registry-linked trialAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in European heart journal, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01747174 (Randomized Controlled Trial Comparing Intracoronary Administration of Adenosine or Sodium Nitroprusside to Control for Attenuation of Microvascular Obstruction During Primary Percutaneous Coronary Intervention), which is not on this map. Cited by 45 papers.

0numbers the graph read from it
0cells of the map it votes in
45citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01747174 phase2completednot on this map

Randomized Controlled Trial Comparing Intracoronary Administration of Adenosine or Sodium Nitroprusside to Control for Attenuation of Microvascular Obstruction During Primary Percutaneous Coronary Intervention

TypeinterventionalSponsorUniversity Hospitals, LeicesterRan2011 to 2014Enrolled247ConditionsST-elevation Myocardial Infarction (STEMI)ArmsIC Adenosine, IC Sodium nitroprusside (SNP), Standard PCI
3 · Its place in the literature

Who cites it

45 citing papers in PubMed.

  1. Trial
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  4. Review
  5. Article
  6. Article
  7. Review
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  9. Article
  10. Review
  11. Article
  12. SCAI Expert Consensus Statement on the Management of Patients With STEMI Referred for Primary PCI.Journal of the Society for Cardiovascular Angiography & Interventions · 2024
    Article
  13. Review
  14. Microvascular Obstruction in Patients With Anterior STEMI Treated With Supersaturated Oxygen.Journal of the Society for Cardiovascular Angiography & Interventions · 2024
    Article
  15. Review
  16. Article
  17. Review
  18. The role and mechanisms of microvascular damage in the ischemic myocardium.Cellular and molecular life sciences : CMLS · 2023
    Review
  19. Review
  20. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors.

Sheraz A NazirDepartment of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK.
Gerry P McCannDepartment of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK.
John P GreenwoodMultidisciplinary Cardiovascular Research Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
Vijay KunadianInstitute of Cellular Medicine, Newcastle University and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
Jamal N KhanDepartment of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK.
Islam Z MahmoudDepartment of Cardiovascular Imaging, Division of Imaging Sciences & Biomedical Engineering, Rayne Institute, BHF Excellence Centre, St Thomas' Hospital, King's College London, London, UK.
Daniel J BlackmanMultidisciplinary Cardiovascular Research Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
Martin BeenDepartment of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
Keith R AbramsDepartment of Health Sciences, School of Medicine, University of Leicester, Leicester, UK.
Lorraine ShipleyDepartment of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK.
Robert WilcoxFaculty of Medicine & Health Sciences, Queen's Medical Centre, Nottingham, UK.
A A Jennifer AdgeyHeart Centre, Royal Victoria Hospital, Belfast, UK.
Anthony H GershlickDepartment of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK agershlick@aol.com.

Funding

Department of Health CDF-2014-07-045Medical Research Council 09/150/28Medical Research Council MC_PC_11002
6 · The paper itself

Abstract

backgroundMicrovascular obstruction (MVO) following primary percutaneous coronary intervention (PPCI) treatment of ST-segment elevation myocardial infarction (STEMI) contributes to infarct expansion, left ventricular (LV) remodelling, and worse clinical outcomes. The REFLO-STEMI trial tested whether intra-coronary (IC) high-dose adenosine or sodium nitroprusside (SNP) reduce infarct size and/or MVO determined by cardiac magnetic resonance (CMR). METHODS AND

resultsREFLO-STEMI, a prospective, open-label, multi-centre trial with blinded endpoints, randomized (1:1:1) 247 STEMI patients with single vessel disease presenting within 6 h of symptom onset to IC adenosine (2-3 mg total) or SNP (500 μg total) immediately following thrombectomy and again following stenting, or to standard PPCI. The primary endpoint was infarct size % LV mass (%LVM) on CMR undertaken 24-96 h after PPCI (n = 197). Clinical follow-up was to 6 months. There was no significant difference in infarct size (%LVM, median, interquartile range, IQR) between adenosine (10.1, 4.7-16.2), SNP (10.0, 4.2-15.8), and control (8.3, 1.9-14.0), P = 0.062 and P = 0.160, respectively, vs. CONTROL: MVO (% LVM, median, IQR) was similar across groups (1.0, 0.0-3.7, P = 0.205 and 0.6, 0.0-2.4, P = 0.244 for adenosine and SNP, respectively, vs. control 0.3, 0.0-2.8). On per-protocol analysis, infarct size (%LV mass, 12.0 vs. 8.3, P = 0.031), major adverse cardiac events (hazard ratio, HR, 5.39 [1.18-24.60], P = 0.04) at 30 days and 6 months (HR 6.53 [1.46-29.2], P = 0.01) were increased and ejection fraction reduced (42.5 ± 7.2% vs. 45.7 ± 8.0%, P = 0.027) in adenosine-treated patients compared with control.

conclusionsHigh-dose IC adenosine and SNP during PPCI did not reduce infarct size or MVO measured by CMR. Furthermore, adenosine may adversely affect mid-term clinical outcome. CLINICAL

trial registrationClinicalTrials.gov Identifier: NCT01747174; https://clinicaltrials.gov/ct2/show/NCT01747174.

Indexed as

Percutaneous Coronary InterventionST Elevation Myocardial InfarctionHumansMagnetic Resonance ImagingProspective StudiesThrombectomyTreatment OutcomeAcute myocardial infarctionAdenosineIschaemia-reperfusion injuryMagnetic resonance ImagingMicrovascular obstructionNitroprusside

Identifiers

PMID27147610
PMCPMC4917746

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.