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Efficiency and Safety of Intracoronary Epinephrine Administration in Patients With ST-Elevation Myocardial Infarction
Vyacheslav Ryabov1, Stanislav Dil1, Evgeny Vyshlov1
1Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russian Federation.
Insights
Intracoronary adrenaline effectively treats refractory no-reflow in ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI). This approach improves coronary flow, reduces microvascular obstruction, and enhances ejection fraction with a comparable safety profile.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Refractory no-reflow during percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) poses a significant clinical challenge.
- Current treatment options for refractory no-reflow are limited, with a need for more effective strategies.
Purpose of the Study:
- To evaluate the efficacy and safety of intracoronary adrenaline administration in patients with STEMI experiencing refractory no-reflow despite conventional treatment.
- To compare coronary flow restoration, myocardial reperfusion, and microvascular obstruction between intracoronary adrenaline and conventional treatments.
Main Methods:
- Prospective randomized study including 90 consecutive STEMI patients with refractory no-reflow after initial PCI.
- Patients were randomized to receive either intracoronary adrenaline (Group 1, n=45) or conventional treatments alone (Group 2, n=45).
- Outcomes assessed included coronary flow restoration (Thrombolysis In Myocardial Infarction grade 3), STEMI resolution, indexed microvascular obstruction (MVO) volume, and ejection fraction (EF).
Main Results:
- Intracoronary adrenaline significantly increased coronary flow restoration (56% vs 29%, p=0.01) and STEMI resolution (78% vs 36%, p<0.001).
- The adrenaline group exhibited lower indexed MVO volume (0.9% vs 1.9%, p=0.048) and improved ejection fraction (p=0.025).
- Intracoronary adrenaline demonstrated a safety profile comparable to conventional treatments regarding life-threatening arrhythmias.
Conclusions:
- Intracoronary adrenaline administration is a more effective strategy than conventional treatments for refractory no-reflow in STEMI patients undergoing PCI.
- This intervention improves coronary artery blood flow, facilitates myocardial reperfusion, enhances cardiac function (EF), and reduces MVO.
- Intracoronary adrenaline represents a promising and safe therapeutic option for managing refractory no-reflow in STEMI.
Abstract:
Studies assessing the treatment of refractory no-reflow in patients with ST-elevation myocardial infarction (STEMI) are limited to clinical cases and pilot studies. This study aimed to evaluate the efficacy and safety of intracoronary adrenaline administration in such patients. Ninety consecutive patients with refractory coronary no-reflow during percutaneous coronary intervention (PCI) were prospectively included after the initial failure of conventional treatment. They were randomized into 2 groups: 45 patients in Group 1 received adrenaline, and 45 patients in Group 2 (control) received conventional treatments alone. After intracoronary drug administration, the adrenaline group demonstrated significantly higher rates of coronary flow restoration in the infarct-related artery to the level of thrombolysis in myocardial infarction grade 3 (56% vs 29% [p = 0.01]) and resolution of STEMI >50% after PCI (78% vs 36% [p <0.001]). Additionally, the adrenaline group showed a lower indexed microvascular obstruction (MVO) volume compared with the control group (0.9 [0.3; 3.1] % vs 1.9 [0.6; 7.9] % [p = 0.048]). A significant improvement in ejection fraction (EF) was observed in the adrenaline group (p = 0.025). Intracoronary adrenaline administration during PCI in patients with STEMI with refractory no-reflow is more effective compared with conventional treatments. This approach improves coronary flow in the infarct-related artery, facilitates a faster resolution of STEMI, enhances EF, and reduces MVO volume. Intracoronary adrenaline administration demonstrates a comparable safety profile to conventional treatment strategies in terms of life-threatening arrhythmias occurrence. The study suggests that intracoronary adrenaline administration during PCI could be an effective treatment strategy for patients with STEMI with refractory no-reflow.
