# Strategieën om microvasculaire obstructie te verminderen bij primaire PCI: RELIEF-MI-trial

*geplaatst 2016-06-21 · Algemeen · European heart journal · doi 10.1093/eurheartj/ehw136 · https://hartvaat.nl/2016/06/21/strategieen-om-microvasculaire-obstructie-te-verminderen-bij-primaire-pci-relief/*

Gerandomiseerde trial naar lokale adjuvante therapie ter vermindering van microvasculaire obstructie tijdens primaire PCI bij STEMI. Onderzocht of lokale behandeling de no-reflow na reperfusie kan beperken.

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

This randomized trial tested local adjuvant therapies to reduce microvascular obstruction during primary PCI for STEMI, exploring whether intracoronary treatments can improve myocardial salvage beyond mechanical reperfusion alone.

## Abstract (original, from the publication)

BACKGROUND: Microvascular 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 RESULTS: REFLO-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. CONCLUSIONS: High-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 REGISTRATION: ClinicalTrials.gov Identifier: NCT01747174; https://clinicaltrials.gov/ct2/show/NCT01747174.

Auteurs: 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, Robert Wilcox, A A Jennifer Adgey, Anthony H Gershlick

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Bron: European heart journal, https://doi.org/10.1093/eurheartj/ehw136. Bijgewerkt 2026-07-03T13:25:31Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.