In patients with acute coronary syndrome, no-reflow prevalence is 32%. Different drugs—such as adenosine, verapamil, nitroprusside, or nicardipine— have been used for its intracoronary treatment, thus resulting in arterial hypotension.
The aim of this randomized study was to determine the effectiveness of the use of intracoronary epinephrine vs. adenosine in normotensive patients.
The primary endpoint was improvement in coronary flow assessed by TIMI flow, frame count, and myocardial blush. The secondary endpoint was in-hospital death, short-term death, and major cardiovascular events.
A total of 201 patients were included; 101 received epinephrine and 100, adenosine. The mean age was 57 years, most patients were male and hypertensive, and almost half of them had diabetes. The most frequent form of presentation in both groups was STEMI (ST-elevation myocardial infarction) and the anterior descending artery was the most frequently affected artery. Pre-treatment TIMI I flow was present in 60% of patients.
Effectiveness was superior in patients who received epinephrine administration with TIMI III end flow (90.1% vs. 78%, p = 0.019), while there were no significant differences in myocardial blush or the secondary endpoint.
Read also: Bypass Grafting and Native Coronary Artery Disease Activity.
Epinephrine was well tolerated with few major adverse effects (2% of patients suffered from ventricular tachycardia).
Conclusion
Epinephrine is relatively safe for use in no-reflow in patients with normotension in acute coronary syndrome. The significant increase in post-treatment TIMI III flow, with a non-significant improvement in myocardial blush, makes intracoronary epinephrine a more effective alternative to adenosine.
Dr. Andrés Rodríguez
Member of the Editorial Board, SOLACI.org
Original Title: Comparison of Intracoronary Epinephrine and Adenosine for No-Reflow in Normotensive Patients With Acute Coronary Syndrome (COAR Trial).
Reference: Kamran Ahmed Khan, et al Circulation Volume 15, Issue 2, February 2022.
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