PMID- 35380062
OWN - NLM
STAT- MEDLINE
DCOM- 20220406
LR  - 20220416
IS  - 0975-4466 (Electronic)
IS  - 0256-4947 (Print)
IS  - 0256-4947 (Linking)
VI  - 42
IP  - 2
DP  - 2022 Mar-Apr
TI  - Intracoronary epinephrine versus adenosine in the management of refractory 
      no-reflow phenomenon: a single-center retrospective cohort study.
PG  - 75-82
LID - 10.5144/0256-4947.2022.75 [doi]
AB  - BACKGROUND: The no-reflow phenomenon is associated with a considerable reduction 
      in myocardial salvage in patients with ST elevation myocardial infarction (STEMI) 
      treated by primary percutaneous intervention (PCI). There has been no 
      head-to-head comparison of intra-coronary epinephrine to adenosine in the 
      management of no-reflow phenomenon. OBJECTIVES: Evaluate the short- and long-term 
      efficacy and safety of using intracoronary epinephrine versus adenosine for 
      management of the catastrophic no-reflow phenomenon that may occur during primary 
      PCI. DESIGN: Retrospective cohort. SETTING: Single center in Egypt. PATIENTS AND 
      METHODS: The study included STEMI patients who developed refractory no-reflow 
      phenomenon during primary PCI after failure of conventional treatments and 
      received either intracoronary epinephrine or adenosine. MAIN OUTCOME MEASURES: 
      No-reflow management measured through improvement of thrombolysis in myocardial 
      infarction grade (TIMI flow), myocardial blush grade, TIMI frame count and major 
      adverse cardiovascular events (MACE) at 1-year follow up. SAMPLE SIZE: 156 
      patients with refractory no-reflow phenomenon during primary PCI. RESULTS: 
      Successful reperfusion was achieved in 74 of 81 (91.4%) of patients who received 
      epinephrine and in 65 of 75 (86.7%) who received adenosine (P<.05). Fifty-six of 
      81 patients (69.1%) achieved TIMI III flow after epinephrine administration 
      versus 39 of 75 patients (52.7%) in the adenosine group (P=.04). The incidence of 
      heart failure after 1 year of follow up was lower in the epinephrine group 
      compared to the adenosine group (6.3% vs. 19.2%, P<.017). MACE after 1 year of 
      follow up was lower in patients who received epinephrine compared to those who 
      received adenosine (11.3 % Vs. 26.7 %, P<.01). CONCLUSION: During primary PCI, 
      intracoronary epinephrine is as effective as adenosine in successful management 
      of refractory no-reflow phenomenon with a more favorable long-term prognosis 
      compared to adenosine. LIMITATIONS: Retrospective design. CONFLICT OF INTEREST: 
      None.
FAU - Darwish, Ahmed
AU  - Darwish A
AUID- ORCID: 0000-0001-8400-3492
AD  - From the Department of Cardiology, Zagazig University, Zagazig, Egypt.
FAU - Frere, Abdel-Fattah
AU  - Frere AF
AD  - From the Department of Cardiology, Zagazig University, Zagazig, Egypt.
FAU - Abdelsamie, Magdy
AU  - Abdelsamie M
AD  - From the Department of Cardiology, Zagazig University, Zagazig, Egypt.
FAU - Awady, Waleed El
AU  - Awady WE
AD  - From the Department of Cardiology, Zagazig University, Zagazig, Egypt.
FAU - Gouda, Mohammad
AU  - Gouda M
AD  - From the Department of Cardiology, Zagazig University, Zagazig, Egypt.
LA  - eng
PT  - Journal Article
DEP - 20220407
PL  - Saudi Arabia
TA  - Ann Saudi Med
JT  - Annals of Saudi medicine
JID - 8507355
RN  - K72T3FS567 (Adenosine)
RN  - YKH834O4BH (Epinephrine)
SB  - IM
MH  - Adenosine/adverse effects
MH  - Epinephrine
MH  - Humans
MH  - *No-Reflow Phenomenon/drug therapy
MH  - *Percutaneous Coronary Intervention
MH  - Retrospective Studies
PMC - PMC8981999
EDAT- 2022/04/06 06:00
MHDA- 2022/04/07 06:00
PMCR- 2022/03/01
CRDT- 2022/04/05 08:38
PHST- 2022/04/05 08:38 [entrez]
PHST- 2022/04/06 06:00 [pubmed]
PHST- 2022/04/07 06:00 [medline]
PHST- 2022/03/01 00:00 [pmc-release]
AID - 0256-4947.2022.75 [pii]
AID - 10.5144/0256-4947.2022.75 [doi]
PST - ppublish
SO  - Ann Saudi Med. 2022 Mar-Apr;42(2):75-82. doi: 10.5144/0256-4947.2022.75. Epub 
      2022 Apr 7.