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Intracoronary Vasoactive Therapy for No-Reflow During Primary PCI: A Network Meta-Analysis of Randomized Trials
Federico Oliveri1, Lorenzo Tua2, Luca Raone2
1Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
JACC. Advances
|February 25, 2026
Summary
Intracoronary verapamil and epinephrine improved coronary blood flow after percutaneous coronary intervention for no-reflow phenomenon. These agents showed better outcomes than control, but did not reduce major adverse cardiovascular events or mortality.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- The no-reflow phenomenon is a common complication of primary percutaneous coronary intervention.
- It is associated with poor patient outcomes, yet effective pharmacological treatments are limited.
Purpose of the Study:
- To compare the efficacy of commonly used intracoronary medications for treating the no-reflow phenomenon.
- Evaluate intracoronary adenosine, epinephrine, nitroprusside, and verapamil.
Main Methods:
- Systematic review and frequentist network meta-analysis of randomized controlled trials.
- Included 13 studies with 1,674 patients undergoing primary percutaneous coronary intervention.
- Primary endpoint: restoration of TIMI flow grade 3; Secondary endpoints: ST-segment resolution, MACE, and mortality.
Main Results:
- Epinephrine and verapamil significantly increased odds of achieving TIMI flow grade 3 compared to control.
- Epinephrine, verapamil, and adenosine improved ST-segment resolution.
- No significant reduction in major adverse cardiovascular events or mortality observed for any agent.
Conclusions:
- Intracoronary verapamil and epinephrine are effective in improving coronary blood flow in no-reflow cases.
- Further research is necessary to determine the optimal agent for clinical practice.
Keywords:
(adenosine OR epinephrine OR nitroprusside OR verapamil) AND no-reflowadenosine epinephrinenitroprussideno-reflowverapamilMore Related Videos
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