Comparison of routine vascular bed preparation versus need based vascular bed preparation in patients undergoing primary PCI

Primary percutaneous coronary intervention (PCI) is one of the most effective treatments for acute ST-segment elevation myocardial infarction (STEMI). However, despite the presence of normal epicardial flow, post-procedural microvascular obstruction (MVO) which substantially reduces the beneficial effects of PCI, remains an important limitation of the procedure.Since presence of no-reflow is related to higher risk of major adverse cardiac events (MACE) due to the poor healing of the infarct, adverse left ventricular remodeling, congestive heart failure occurrence and death. There is paucity of data with respect to vascular bed preparation prior to primary PCI in patients with STEMI. Currently, there is still a lack of an optimal treatment for no-reflow phenomenon. Prevention can be effective to reduce no-reflow occurrence with medical therapy. Hence, various strategies to prevent no reflow like vascular bed preparation prior to primary PCI can be beneficial, as our aim of revascularization is to improve coronary blood flow at the level of microcirculation to reduce myocardial damage and improve clinical outcome. Various centers are practicing vascular bed preparation prior to primary PCI, in our hospital also both (intracoronary vasodilator via guiding catheter followed by primary PCI and targeted intracoronary delivery of vasodilator followed by primary PCI) methods of vascular bed preparation is being practiced. There is no standard guideline at present for the various methods of intracoronary therapies prior to primary PCI. Therefore, this study is designed with the aim of role of various methods of vascular bed preparation prior to primary PCI.