Heart Attack Blood Flow Technique Shows No Clear Gain
Adults receiving emergency angioplasty for heart attack saw no significant overall reduction in slow blood flow with this approach.
Updated on Nov. 3, 2026 in Heart Disease
A randomized trial of 174 patients with type 1 STEMI found that adding perfusion balloon predilation with intracoronary Nicorandil did not significantly reduce slow-flow or no-reflow compared with direct stenting during primary PCI. The findings were presented at TCT 2026, and the results are relevant to clinicians and patients in heart attack care worldwide.
Why it matters
Slow-flow and no-reflow are complications that can reduce blood flow to heart muscle during emergency angioplasty for a heart attack, so reducing them is a practical goal in treatment. This trial tested a specific technique intended to prevent them and found no significant overall benefit on its primary measure, which helps clinicians and researchers decide where to focus next.
This randomized trial enrolled 174 patients with type 1 STEMI within 24 hours of symptom onset and compared perfusion balloon predilation against direct stenting. The primary endpoint, slow-flow or no-reflow, showed no significant difference between groups (48.8% vs. 54.2%, p=0.51).
The details
In primary PCI, the heart's arteries are reopened with a balloon and stent, but blood flow in the tiny vessels downstream can remain sluggish or blocked, a problem known as slow-flow or no-reflow. The technique tested here used a perfusion balloon, delivered with the Rx Ryusei device, to deliver intracoronary Nicorandil, a drug intended to relax those small vessels. The trial compared this approach against direct stenting, where the stent is placed without this preparatory step.
Timeline
Patients were enrolled within 24 hours of the onset of heart attack symptoms.
The TomorrowLAND trial findings were presented at TCT 2026.
Health Landscape
Intracoronary vasodilators such as Nicorandil have been explored as adjuncts during primary PCI to counter no-reflow, a complication that can limit the benefit of reopening a blocked artery. TomorrowLAND adds a randomized comparison to that research, and its null primary result tempers expectations for this specific perfusion balloon approach.
Patients who have had a heart attack, and those who may be at risk, should understand that this trial did not find a significant benefit from this specific technique for reducing slow blood flow. Anyone with questions about how emergency heart care is delivered can raise them with their cardiologist.
The takeaway
Reopening a blocked heart artery remains the central goal in heart attack care, and this trial shows that a specific preparatory technique did not significantly reduce slow blood flow overall. If you have heart disease risk factors or questions about emergency cardiac care, talking with your cardiologist is the right next step.
Further reading
For more background on the conditions behind this research, explore our Heart Disease coverage.
