Resolution of refractory no‐reflow with intracoronary epinephrine

Abstract

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.

2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention

“…676,678,679,681,684,686,689,691 There are fewer data to support the use of epinephrine. 692 No-reflow after rotational atherectomy was less common with nicorandil compared with verapamil infusions in 3 studies, [693][694][695] and an infusion of nicorandil/adenosine during rotational atherectomy prevented no-reflow in 98% of patients. 677 Trials of pre-PCI intracoronary verapamil, nicardipine, and adenosine have reported them to be safe but have not demonstrated reductions in post-PCI no-reflow.…”

Coronary Hyperemic Dose Responses of Intracoronary Sodium Nitroprusside

“…14, 15 Rossen et al 14 reported that the administration of a 125-or 250-g/kg bolus of intravenous diltiazem followed by a 5-g/kg per minute infusion in 8 patients reduced heart rate (77Ϯ18 to 72Ϯ17 bpm, PϽ0.005) and mean arterial pressure (96Ϯ11 to 86Ϯ15 mm Hg, PϽ0.005) while decreasing coronary flow reserve from 3.9Ϯ1.2 to 3.6Ϯ1.1 (PϽ0.01). 5 In 10 patients treated with IC diltiazem, in dosages of 150 to 600 g given as bolus infusions, mean arterial pressure was unchanged. The heart rate was maintained constant by atrial pacing.…”

Intracoronary Administration of Abciximab in ST-Elevation Myocardial Infarction

“…Compared with the systemic administration of intravenous pharmacotherapies, highly localized administration of intracoronary pharmacotherapy may be associated with a several-hundred-fold increase in the local concentration of an agent in the epicardial artery and microcirculation. A number of pharmacotherapies, including adenosine, 5,6 calcium channel blockers, 7 ␣-blockers, 8 ␤ 2 -receptor activators, 9 other vasodilators, antithrombotics, 10,11 and antiplatelet agents, [12][13][14] have been used to treat microvascular dysfunction.…”