Online ISSN: 2515-8260

Keywords : Combination therapy

Role of Combination therapy on no-reflow after primarypercutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction

Kamal S. Mansor, Tarek A. Naguib, Tamer M. Mostafa, Mohamed M. Moukhtar

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 3, Pages 4011-4025

Background: Primary percutaneous coronary intervention (PCI) has been shown to be the most
effective reperfusion strategy in the treatment of acute myocardial infarction (AMI).
Aim of the Work:To investigate the association the effectiveness of a combination therapy
(pretreatment with high dose atorvastatin and Intra Coronary tirofiban) for the prevention of noreflow
in patient with acute STEMI will undergo primary PCI.
Patients and Methods: This study enrolled 100 patients admitted with first acute STEMI and at high
clinical risk for no Reflow. High risk patients (no-reflow score ≥ 8) were randomly divided into a
controlled group A (50 patients) received conventional treatment and a combination therapy group
B(50 patients) received combination treatment (atorvastatin 80 mg and IC tirofiban).The patient was
considered to exhibit a no-reflow phenomenon if blood flow in the IRA was a TIMI≤2 flow despite
successful dilatation and absence of mechanical complications such as dissection, spasm or
angiographically evident distal embolization after completion of the procedure.
Results: The rate of no-reflow was significantly lower in combination therapy group (10 %)
compared to control group (36%).Regarding Indirect perfusion outcome: We found that percent of
ST resolution and peak CKMB were significantly higher in combination therapy compared to control
group (P value = 0.013 – 0.001 respectively).Ejection fraction tend to be higher in the combination
therapy group but not statistically significant (P>0.05).Regarding in hospital complication and 30
days MACE; we found that heart failure symptoms were significantly lower in combination group
therapy during in hospital stay and at 30 days follow up (3% and 2% respectively). The composite end
point of 30 days MACE occur only in 3% in combination therapy group while 10 % in control group
(P =0.033). using Kaplan Meier curve for free survival MACE at 30 days there were also significant
different regarding free event rate for MACE, log rank =4.737, P =0.030. We also observed that high
thrombotic burden (thrombus grade ≥ 4) was independent predictor for angiographic no reflow (p
=0.012), and the use of combination therapy were strongly independent predictors for prevention of
no reflow (p =0.002) with relative Risk reduction 72.2% and absolute risk reduction = 26%.
Conclusion: Combination of pre-procedure high dose atorvastatin and IC bolus tirofiban can
effectively reduce the incidence of no-reflow after primary PCI in patients with acute myocardial
infarction who are at high risk of no-reflow.Large thrombus load is independent predictor of
angiographic no reflow after primary PCI. However, this combination therapy is strong independent
predictors for prevention of angiographic no-reflow.