Electroacupuncture for Slow Flow/No-Reflow in Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention: A Pilot Randomized Controlled Trial

Abstract

Background: Slow flow/no-reflow (SF-NR) complicates up to 44% of percutaneous coronary interventions (PCI) for acute myocardial infarction (AMI), worsening prognosis. Electroacupuncture (EA) may mitigate SF-NR, but clinical evidence is limited. Objective：This trial was designed to assess the feasibility and effectiveness of intraoperative EA in reducing SF-NR during PCI for AMI patients. Design, Setting, and Participants and Interventions: This single-center, randomized, assessor-blinded pilot trial enrolled 60 eligible AMI patients undergoing PCI at Yueyang Hospital, China, from August 2023 to March 2024. Participants were randomized to receive PCI with electroacupuncture (EA) stimulating Neiguan (PC6) and Ximen (PC4) acupoints, or PCI alone (control group). Main Outcomes and Measures: The primary outcome was the incidence of SF-NR. Secondary outcomes included chest pain (Numerical Rating Scale, NRS), anxiety (Visual Analog Scale for Anxiety, VAS-A), and the occurrence of major adverse cardiac and cerebrovascular events (MACCE) within 30 days, cardiac biomarkers, inflammatory markers. Results: All 60 patients completed the trial (mean [SD] age, 63.2 [11.4] years; 86.7% male [52/60]). EA significantly reduced SF-NR incidence compared with control (6.7% [2/30] vs 26.7% [8/30]; RR, 0.2; 95% CI, 0.0 to 0.4; P = .04). EA also significantly reduced median pain scores (0h post-PCI: median difference, -2.5 [95% CI, -3.3 to -0.7]; 12h post-PCI: median difference, -3.0 [95% CI, -3.5 to -1.9]; both P < .001), anxiety scores (0h post-PCI: median difference, -2.0 [95% CI, -2.8 to -0.2]; 12h post-PCI: median difference, -2.0 [95% CI, -3.3 to -1.1]; both P < .001). No significant differences were found in cardiac biomarkers or 30-day MACCE (16.7% [5/30] vs 36.7% [11/30]; P = .09). However, EA was associated with inflammatory markers at 12 hours (Leukocytes, P = .03; Neutrophils, P = .04; high-sensitivity C-reactive protein, P = .03). No adverse events were reported. Conclusions: Intraoperative EA during PCI was associated with reduced SF-NR and attenuated early inflammation. Improvements in patient-reported pain and anxiety were also observed, though the influence of may non-specific effects. These preliminary findings demonstrate the feasibility of EA as a PCI adjunct and indicate a potential signal for efficacy, larger multicenter, sham-controlled trials larger multicenter, sham-controlled trials are needed.