EFFICACY AND SAFETY OF LOCAL INTRACORONARY ADRENALINE IN THE TREATMENT OF NO RE-FLOW PHENOMENON

Authors

  • Y SAOOD Department of Cardiology, Ayub Teaching Hospital Abbottabad, Pakistan
  • SIA KAZMI Department of Cardiology, Women Medical College Abbottabad, Pakistan
  • A SALMAN Department of Cardiology, Saidu Medical College / Saidu Group of Teaching Hospital Swat, Pakistan
  • MI KHAN Department of Cardiology, Peshawar Institute of Cardiology, Pakistan
  • R ZAFAR Department of Medicine, Teaching Hospital Kech, Turbat, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2023i1.434

Abstract

No flow is defined as the lack of myocardial perfusion despite opening up the epicardial coronary vessels in percutaneous coronary intervention (PCI). The study aims to find the efficacy and safety of local intracoronary adrenaline in treating the no-reflow phenomenon. This prospective observational study was conducted at the Peshawar Institute of Cardiology from January 2021 to January 2022. Data was collected from 86 patients. Data was collected through clinical assessments, angiographic evaluations, and patient records. Relevant baseline characteristics, procedural details, and outcomes were systematically documented for each participant. The average age of the participants was 62 years, with a gender distribution of 60% male and 40% female. Among the 86 patients, 42% exhibited an angiographically confirmed no-reflow phenomenon during PCI. No-reflow severity varied, with 18% experiencing mild, 15% moderate, and 9% severe no-reflow. Local intracoronary adrenaline was administered as part of the treatment strategy for the no-reflow phenomenon in the eligible patients. The standardized dose of adrenaline used was 100 μg, administered via the intracoronary route during the PCI procedure. It is concluded that local intracoronary adrenaline administration appears to be a potentially effective and safe strategy for managing the no-reflow phenomenon during PCI procedures.

Downloads

Download data is not yet available.

References

Abu Arab, T., Rafik, R., and El Etriby, A. (2016). Efficacy and safety of local intracoronary drug delivery in treatment of no‐reflow phenomenon: A pilot study. Wiley Online Library.

Aksu, T., Guler, T. E., Colak, A., Baysal, E., Durukan, M., Sen, T., and Guray, U. (2015). Intracoronary epinephrine in the treatment of refractory no-reflow after primary percutaneous coronary intervention: a retrospective study. BMC cardiovascular disorders 15, 1-7.

Darwish, A., Frere, A.-F., Abdelsamie, M., Awady, W. E., and Gouda, M. (2022). Intracoronary epinephrine versus adenosine in the management of refractory no-reflow phenomenon: a single-center retrospective cohort study. Annals of Saudi Medicine 42, 75-82.

Hassan, A., Mohamed, H., Mohamed, A., and Kishk, Y. (2018). P5579 Predictors of No-reflow in Primary PCI patients with novel insight on thrombus aspiration. European Heart Journal 39, ehy566. P5579.

Ibanez, B., James, S., Agewall, S., Antunes, M. J., Bucciarelli-Ducci, C., Bueno, H., Caforio, A. L., Crea, F., Goudevenos, J. A., and Halvorsen, S. (2018). 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). European heart journal 39, 119-177.

Jafari Afshar, E., Samimisedeh, P., Tayebi, A., Shafiabadi Hassani, N., Rastad, H., and Yazdani, S. (2023). Efficacy and safety of intracoronary epinephrine for the management of the no-reflow phenomenon following percutaneous coronary interventions: a systematic-review study. Therapeutic Advances in Cardiovascular Disease 17, 17539447231154654.

Khan, K. A., Qamar, N., Saghir, T., Sial, J. A., Kumar, D., Kumar, R., Qayyum, D., Yasin, U., Jalbani, J., and Karim, M. (2022). Comparison of intracoronary epinephrine and adenosine for no-reflow in normotensive patients with acute coronary syndrome (COAR trial). Circulation: Cardiovascular Interventions 15, e011408.

Kobatake, R., Sato, T., Fujiwara, Y., Sunami, H., Yoshioka, R., Ikeda, T., Saito, H., and Ujihira, T. (2011). Comparison of the effects of nitroprusside versus nicorandil on the slow/no-reflow phenomenon during coronary interventions for acute myocardial infarction. Heart and vessels 26, 379-384.

Munn, Z., Barker, T. H., Moola, S., Tufanaru, C., Stern, C., McArthur, A., Stephenson, M., and Aromataris, E. (2020). Methodological quality of case series studies: an introduction to the JBI critical appraisal tool. JBI evidence synthesis 18, 2127-2133.

Petronio, A. S., De Carlo, M., Ciabatti, N., Amoroso, G., Limbruno, U., Palagi, C., Di Bello, V., Romano, M. F., and Mariani, M. (2005). Left ventricular remodeling after primary coronary angioplasty in patients treated with abciximab or intracoronary adenosine. American heart journal 150, 1015.1-1015. e9.

Poon, K., Seth, M., Dixon, S., and Gurm, H. (2013). The clinical implications and predictors of no reflow phenomenon in contemporary PCI: Insights from blue cross blue shield of Michigan cardiovascular collaborative Bmc2. Journal of the American College of Cardiology 61, E133-E133.

Rezkalla, S. H., Stankowski, R. V., Hanna, J., and Kloner, R. A. (2017). Management of no-reflow phenomenon in the catheterization laboratory. JACC: Cardiovascular Interventions 10, 215-223.

Tasar, O., Karabay, A. K., Oduncu, V., and Kirma, C. (2019). Predictors and outcomes of no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Coronary artery disease 30, 270-276.

Vlaar, P. J., Svilaas, T., van der Horst, I. C., Diercks, G. F., Fokkema, M. L., de Smet, B. J., van den Heuvel, A. F., Anthonio, R. L., Jessurun, G. A., and Tan, E.-S. (2008). Cardiac death and reinfarction after 1 year in the Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS): a 1-year follow-up study. The Lancet 371, 1915-1920.

Wang, L., Cheng, Z., Gu, Y., and Peng, D. (2015). Short-term effects of verapamil and diltiazem in the treatment of no reflow phenomenon: a meta-analysis of randomized controlled trials. BioMed Research International 2015.

Yassin, I., Ahmed, A., and Abdelhady, G. (2021). Distal intracoronary delivery of epinephrine versus verapamil to prevent no-reflow during primary percutaneous coronary intervention: a randomized, open-label, trial. Cardiol Vasc Res 5, 1-6.

Downloads

Published

2023-10-05

How to Cite

SAOOD , Y., KAZMI , S., SALMAN , A., KHAN , M., & ZAFAR , R. (2023). EFFICACY AND SAFETY OF LOCAL INTRACORONARY ADRENALINE IN THE TREATMENT OF NO RE-FLOW PHENOMENON. Biological and Clinical Sciences Research Journal, 2023(1), 434. https://doi.org/10.54112/bcsrj.v2023i1.434

Most read articles by the same author(s)

1 2 > >>