Patients with acute myocardial infarction may harbor multiple complex coronary plaques that are associated with adverse clinical outcomes. Plaque instability may be due to a widespread process throughout the coronary vessels, which may have implications for the management of acute ischemic heart disease.

In patients with right ventricular infarction, complete reperfusion of the right coronary artery by angioplasty results in the dramatic recovery of right ventricular performance and an excellent clinical outcome. In contrast, unsuccessful reperfusion is associated with impaired recovery of right ventricular function, persistent hemodynamic compromise, and a high mortality rate.

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Refractory no-reflow is associated with adverse outcomes in patients undergoing percutaneous coronary intervention. Charts were reviewed to identify 29 consecutive patients in whom intracoronary epinephrine was administered for refractory no-reflow. The effects of intracoronary epinephrine on coronary flow (TIMI grade), cardiac rhythm, and systolic blood pressure in the cardiac catheterization laboratory were assessed. Administration of intracoronary epinephrine (mean dose, 139 +/- 189 microg) resulted in significant improvement in coronary flow. After administration, TIMI 3 flow was established in 69% of patients. Overall, TIMI flow significantly increased (mean TIMI flow form 1.0 +/- 1.0 to 2.66 +/- 0.55; P = 0.0001). Intracoronary epinephrine resulted in significant but tolerable increase in heart rate (72 +/- 19 to 86 +/- 26 beats/min; P = 0.009), but no cases of acute dysrhythmia. These findings indicate that intracoronary epinephrine may exert salutary effects in patients suffering refractory no-reflow following elective or acute coronary interventions.

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