Abu Arab Tamer, Rafik Ramy, El Etriby Adel
Department of Cardiology, Ain Shams University Hospitals, Cairo, Egypt.
J Interv Cardiol. 2016 Oct;29(5):496-504. doi: 10.1111/joic.12318. Epub 2016 Jul 27.
Successful reopening of epicardial coronary artery does not always mean optimal myocardial reperfusion in a sizable portion of patients, mostly because of no-reflow phenomenon.
We investigated whether local injection of adrenaline ± verapamil in the distal coronary bed is more effective than their intracoronary (IC) injection through the guiding catheter in the treatment of no-reflow phenomenon following percutaneous coronary intervention (PCI).
A total of 40 patients with no-reflow following PCI were randomized into two groups. Group 1 received IC adrenaline ± verapamil through a well-cannulated guiding catheter while Group 2 received the above-mentioned drugs in the distal coronary bed through a perfusion balloon or selective microcatheter. The primary end points were the achievement of TIMI III flow with MBG II or III. Secondary end points were the occurrence of hypotension, arrhythmias, and major adverse cardiac events (MACEs) during hospital stay.
After drug injection, the percentage of patients achieving Thrombolysis in Myocardial Infarction (TIMI) III flow in Group 1 was 40% versus 80% in Group 2, P = 0.032. MBG II and III was significantly lower in Group 1; 10% and 25% versus 15% and 65% in Group 2, respectively, P = 0.033. Primary end points were achieved in only 35% of patients in Group 1 and in 80% of patients in Group 2 (odds ratio, 7.43, 95% confidence interval 1.78-31.04, P < 0.01). Secondary end points were not different between both groups.
Local intra-coronary delivery of adrenaline ± verapamil is a safe and effective method for the treatment of no-reflow phenomenon complicating PCI.
在相当一部分患者中，心外膜冠状动脉成功再通并不总是意味着最佳的心肌再灌注，主要原因是无复流现象。
我们研究了在冠状动脉远端床局部注射肾上腺素±维拉帕米是否比通过引导导管冠状动脉内（IC）注射更有效地治疗经皮冠状动脉介入治疗（PCI）后出现的无复流现象。
总共40例PCI后出现无复流的患者被随机分为两组。第1组通过良好插管的引导导管接受IC肾上腺素±维拉帕米，而第2组通过灌注球囊或选择性微导管在冠状动脉远端床接受上述药物。主要终点是达到心肌梗死溶栓（TIMI）III级血流且心肌灌注分级（MBG）为II级或III级。次要终点是住院期间低血压、心律失常和主要不良心脏事件（MACE）的发生情况。
注射药物后，第1组达到TIMI III级血流的患者百分比为40%，而第2组为80%，P = 0.032。第1组的MBG II级和III级明显更低，分别为10%和25%，而第2组为15%和65%，P = 0.033。第1组仅35%的患者达到主要终点，第2组为80%（优势比，7.43，95%置信区间1.78 - 31.04，P < 0.01）。两组之间次要终点无差异。
冠状动脉内局部注射肾上腺素±维拉帕米是治疗PCI并发无复流现象的一种安全有效的方法。
