Eliano P Navarese1,2,3, Lara Frediani4, David E Kandzari5, Gianluca Caiazzo6, Angela Marella Cenname7, Bernardo Cortese8, Tommaso Piva9, Andi Muçaj9, Carlo Tumscitz10, Francesco Paparoni11, Claudio Larosa12, Teodoro Bisceglia13, Mila Menozzi14, Paul A Gurbel15, Jacek Kubica1. 1. Department of Cardiology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland. 2. SIRIO MEDICINE Network, Bydgoszcz, Poland. 3. Faculty of Medicine University of Alberta, Edmonton, Canada. 4. Department of Cardiology, Livorno Hospital, Azienda Usl Toscana Nord-Ovest, Ospedali Riuniti di Livorno, Livorno, Italy. 5. Piedmont Heart Institute, Atlanta, Georgia, USA. 6. U.O. Cardiologia-UTIC, P.O. San Giovanni Moscati, Aversa, Italy. 7. Catholic University of the Sacred Heart, Rome, Italy. 8. Interventional Cardiology Research, Milan, Italy. 9. Department of Cardiologic, Azienda Ospedaliero Universitaria "Ospedali Riuniti", Ancona, Italy. 10. University Hospital of Ferrara, Ferrara, Italy. 11. Interventional Cardiology, Azienda Usl, Pescara, Italy. 12. Department of Cardiology, Azienda Ospedaliera Bonomo, Andria, Italy. 13. Department of Cardiology, Santa Maria della Misericordia Hospital, Udine, Italy. 14. Azienda USL degli Infermi, Rimini, Italy. 15. Sinai Center form Thrombosis Research, Sinai Hospital of Baltimore, Baltimore, Maryland, USA.
Abstract
OBJECTIVES: We aimed to compare intracoronary (IC) epinephrine versus conventional treatments alone in patients with ST-elevation myocardial infarction and refractory coronary no-reflow during primary percutaneous coronary intervention (PPCI). METHODS: Thirty consecutive patients with severe refractory coronary no-reflow (TIMI 0-1, MBG 0-1) during PPCI were prospectively included after initial failure of conventional treatments. Conventional treatments used in both groups included IC nitrates, thrombectomy. Glycoprotein IIb/IIIa inhibitors and adenosine. Patients received IC epinephrine or no epinephrine. RESULTS: Intracoronary administration of epinephrine yielded significantly better coronary flow patterns (28.6% TIMI 3, 64.3% TIMI 2, 7.1% TIMI 1, and 0% TIMI 0), compared to those after treatment with conventional agents alone (18.8% TIMI 3, 12.5% TIMI 2, 37.5% TIMI 1, and 31.3% TIMI 0) (p value between groups = .004). In the IC epinephrine vs. no epinephrine group there was a significant reduction of 30-day composite of death or heart failure (35.7% vs. 81.25%), improvement of ejection fraction (p = .01) and ST-segment resolution (p = .01). CONCLUSIONS: The findings of this proof-of-concept study suggest that as compared to use of conventional agents alone, IC epinephrine provides substantial improvement of coronary flow in STEMI patients with refractory no-reflow during PPCI that may result into improved prognosis.
OBJECTIVES: We aimed to compare intracoronary (IC) epinephrine versus conventional treatments alone in patients with ST-elevation myocardial infarction and refractory coronary no-reflow during primary percutaneous coronary intervention (PPCI). METHODS: Thirty consecutive patients with severe refractory coronary no-reflow (TIMI 0-1, MBG 0-1) during PPCI were prospectively included after initial failure of conventional treatments. Conventional treatments used in both groups included IC nitrates, thrombectomy. Glycoprotein IIb/IIIa inhibitors and adenosine. Patients received IC epinephrine or no epinephrine. RESULTS: Intracoronary administration of epinephrine yielded significantly better coronary flow patterns (28.6% TIMI 3, 64.3% TIMI 2, 7.1% TIMI 1, and 0% TIMI 0), compared to those after treatment with conventional agents alone (18.8% TIMI 3, 12.5% TIMI 2, 37.5% TIMI 1, and 31.3% TIMI 0) (p value between groups = .004). In the IC epinephrine vs. no epinephrine group there was a significant reduction of 30-day composite of death or heart failure (35.7% vs. 81.25%), improvement of ejection fraction (p = .01) and ST-segment resolution (p = .01). CONCLUSIONS: The findings of this proof-of-concept study suggest that as compared to use of conventional agents alone, IC epinephrine provides substantial improvement of coronary flow in STEMI patients with refractory no-reflow during PPCI that may result into improved prognosis.
Authors: Ahmed Darwish; Abdel-Fattah Frere; Magdy Abdelsamie; Waleed El Awady; Mohammad Gouda Journal: Ann Saudi Med Date: 2022-04-07 Impact factor: 1.526