Evidence map›Paper›PMID 29320987›Full record

ReviewBMC cardiovascular disorders2018

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.

Xiaowei Niu, Jingjing Zhang, Ming Bai, Yu Peng, Shaobo Sun, Zheng Zhang

Open access · goldAbstract readReviewNetwork Meta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Review in BMC cardiovascular disorders, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
22citing papers in PubMed, 4 pooled it
3.6field-weighted citation impact, top 6% of its field
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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

22 citing papers in PubMed, 4 syntheses or guidelines pooled it, 45 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 3 institutions in 1 country.

Xiaowei NiuThe First School of Clinical Medicine, Lanzhou University, Tianshui South Road, No. 222, Lanzhou, Gansu, 730000, China.
Jingjing ZhangBaiyin Second People's Hospital, Gongyuan Road, No. 509, Baiyin, Gansu, 730900, China.
Ming BaiDepartment of Cardiology, the First Hospital of Lanzhou University, Donggang West Road, No. 1, Lanzhou, Gansu, 730000, China.
Yu PengDepartment of Cardiology, the First Hospital of Lanzhou University, Donggang West Road, No. 1, Lanzhou, Gansu, 730000, China.
Shaobo SunKey Lab of Prevention and Treatment for Chronic Disease, Gansu University of Chinese Medicine, Dingxi East Road, No. 35, Lanzhou, Gansu, 730000, China.
Zheng ZhangDepartment of Cardiology, the First Hospital of Lanzhou University, Donggang West Road, No. 1, Lanzhou, Gansu, 730000, China. zhangccu@163.com.ORCID 0000-0002-7917-7057
First Hospital of Lanzhou University · CNGansu University of Traditional Chinese Medicine · CNLanzhou University · CN

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDespite 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.

methodsDatabase 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.

resultsForty-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.

conclusionsThe 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.

Indexed as

AgedBayes TheoremCoronary CirculationFemaleHumansMaleMiddle AgedNo-Reflow PhenomenonOdds RatioPercutaneous Coronary InterventionRisk FactorsSolanaceous AlkaloidsST Elevation Myocardial InfarctionTreatment OutcomeVasodilator AgentsanisodamineSolanaceous AlkaloidsVasodilator AgentsIntracoronary; pharmacologyMeta-analysisNo reflow phenomenonPercutaneous coronary intervention

Identifiers

PMID29320987
PMCPMC5763527
OpenAlexW2783303866

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.