Sub-analysis of perfusion balloon predilatation with intracoronary nicorandil vs. distal protection for acute coronary syndrome: A comparative evaluation

Objectives: Slow-flow or no-reflow events occur as a complication during percutaneous coronary intervention for acute coronary syndrome (ACS). A previous study demonstrated that prolonged perfusion balloon (PB) predilatation combined with intracoronary administration of nicorandil attenuates this phenomenon. This subanalysis compared the efficacy of the PB approach with that of conventional distal protection (DP). Methods: The study had a retrospective, single-center, observational design and included patients who underwent percutaneous coronary intervention for ACS between April 2020 and April 2022. The patients were divided into a PB group and a DP group. The PB group underwent thrombus aspiration, followed by 3 minutes of predilatation using the Ryusei® PB, with simultaneous intracoronary administration of nicorandil 2 mg without a DP device and subsequent placement of a drug-eluting stent. The DP group underwent direct stenting or predilatation with a standard balloon combined with a DP device without a PB. Primary endpoints included the incidence of slow-flow or no-reflow events. Results: Sixty-four patients with ACS were enrolled (PB group, n=32; DP group, n=32). The incidence of slow-flow or no-reflow events was significantly lower in the PB group (3.1% vs. 46.8%, p<0.01), as was procedure time (87.1±26.4 minutes vs. 108.6±42.3 minutes, p=0.02) and volume of contrast used (186.0±65.0 mL vs. 228±75.8 mL, p=0.02). Conclusions: PB predilatation with intracoronary nicorandil significantly reduced the number of slow-flow or no-reflow events, shortened procedure time, and reduced the volume of contrast used. This method could be at least as effective as DP.