Intracoronary epinephrine in the treatment of refractory no-reflow after primary percutaneous coronary intervention: A retrospective study Authors

Objectives: The goal of this study was to evaluate the long-term safety and efficacy of intracoronary epinephrine in reversing refractory no-reflow during primary percutaneous coronary intervention (PCI). Methods: A total of 248 consecutive patients with acute myocardial infarction who had been treated from September 2009 to November 2010 at the Cardiology Department of Turkiye Yuksek Ihtisas Hospital were enrolled retrospectively in this study. Twelve consecutive patients who received intracoronary epinephrine to reverse refractory no-reflow during primary PCI were included the study. The effects of intracoronary epinephrine on qualitative TIMI flow grade and quantitative TIMI frame count, cardiac rhythm, and systolic blood pressure were assessed. Results: A mean of 333±123 mcg of intracoronary epinephrine was used. No-reflow was successfully reversed with complete restoration of TIMI 3 flow in 9 of 12 patients (75%). TIMI flow grade improved from 1.33±0.49 prior to epinephrine to 2.66±0.65 after treatment (p < 0.001). There was improvement in coronary flow of at least one TIMI flow grade in 11 (93%) patients, two flow grades in 5 (42%) cases. TIMI frame count decreased from 56±10 at the time of no-reflow to 19±11 (p < 0.001). Epinephrine therapy was well tolerated without serious adverse hemodynamic or chronotropic effects. Intracoronary epinephrine resulted in significant but tolerable increase in heart rate (68±13 to 95±16 beats/min; p< 0.001) and systolic blood pressure (94±18 to 140±20; p< 0.001). Hypotension associated with no-reflow developed in 5 (42%) patients. During the procedure, intra-aortic balloon pump counterpulsation (IABP) was required in 2 (17%) patients, transvenous pacing in 2 (17%) cases, and both IABP and transvenous pacing in 1 (8%) patients. One patient (3.4%) died despite therapeutic measures. There were two AMI and no death during follow-up. Conclusion: Intracoronary epinephrine may become an effective alternative in patients suffering refractory no-reflow following primary PCI.