The Safety And Effectiveness Of Medication To Prevent/Treat No Reflow After Coronary Stent Implantation: A Meta-analysis

Part I The safety and effectiveness of medication to prevent no reflow:a meta-analysisObjective To evaluate the clinical efficacy and safety of coronary artery medication injection to prevent slow flow/no-reflow phenomenon after coronary stent implantation.Methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, Issue 2), PubMed (1966-2009.1), Embase (1900-2009.1), CBM (1978-2009.2), CNKI (1994-2009.2), VIP (1989-2009.2), Wanfang database (1979-2009.2), et al from their inception to February,2009. All the randomized,placebo-controlled trials (RCTs) about drug prevention for no reflow will be included regardless of blinding. According to the assessment method provided by Cochrane handbook 5.0.2, two searchers extracted information of included literatures independently:Two reviewers independently evaluated the quality of the studies and extracted the data. Meta-analysis was performed by RevMan 5.0 software. The date contained basic information of the studies, patients baseline datas, intervention measures, observing indexes, lost to follow-up and ITT, etc. The Methodological quality was estimated according:the right Randomized methods, blind methods, Allocation concealment and Intention-To-Treat et al.Results Twenty-one randomized controlled trials (RCTs) including 1960 patients were included.The result of meta-analysis showed that Intracoronary adenosin,diltiazem,nicorandil intravenous tirofiban,nicorandil can reduce the incidence of no reflow/slow flow, however intravenous Monteplase and intracoronary Urapidil couldn't. Intracoronary tirofiban,nicorandil and intravenous nicorandil could improve CTFC, however Intracoronary nitroprusside couldn't improve CTFC, Intracoronary adenosine and TNK, intravenous nicorandil could improve TIMI3, however intravenous tirofiban and intracoronary nitroprusside couldn't. intravenous nicorandil could improve LVEF,but Intracoronary Verapamil could't. Intravenous tirofiban didn't rise the incidence of the bleeding complication,but intravenous monteplase did. IntravenousNicorandil could reduce the incidence of VT/VF, but intravenous Monteplase couldn't.All drugs didn't reduce the incidence the death rate.Conclusion Evidences show that adenosin,diltiazem,nicorandil tirofiban could prevent no reflow/slow flow, monteplase and Urapidil could't, However nicorandil also could improve LVEF and reduce complication such as VT/VF. there is a moderate possibility of selection bias, performance bias and publication bias in this review, because of the small number of the included studies, which weakens the strength of the evidence of our resuts. Better evidence from more high-quality randomized controlled trials is needed.Part II The safety and effectiveness of medication for the treatment of no reflow phenomenon after coronary stent implantation:a meta-analysisObjective To evaluate the clinical efficacy and safety of medication for the treatmemt of slow/no-reflow after coronary stent implantation.Method We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 2,2009), PubMed, EMbase, CBM, CNKI, VIP, and WanFang databases from their inception to April 2009. Two reviewers independently evaluated the quality of the included studies and extracted the data. Meta-analyses were performed by RevMan 5.0 software.Result eight randomized controlled trials (RCTs) involving 593 patients were included. The results of meta-analyses showed that urokinase, adenosine, and anisodamine could significantly improve the thrombolysis in myocardial infartion (TIMI) flow. In addition, anisodamine could improve the coronary blood pressure. Urokinase significantly reduced the incidence of malignant ventricular arrhythmias and non-fatal of heart failure during hospitalization, but it could not change the mortality and the incidence of unstable angina, recurrence of myocardial infarction, and ischemic target revascularization.Conclusion Evidence shows that anisodamine, urokinase, urapidil and adenosine can improve TIMI flow and improve myocardial perfusion on the no-reflow patients post coronary stent implantation and urokinase can significantly reduce the incidence of main adverse cardiovascular events. Their clinical application is worthy to be advocated...