Cardiovascular Research Center, Alborz University of Medical Sciences, Karaj, Iran.
Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.
Ther Adv Cardiovasc Dis. 2023 Jan-Dec;17:17539447231154654. doi: 10.1177/17539447231154654.
Currently, no pharmacological or device-based intervention has been fully proven to reverse the no-reflow phenomenon.
To assess the efficacy and safety of intracoronary (IC) epinephrine in the management of no-reflow phenomenon following percutaneous coronary intervention (PCI), either as first-line treatment or after the failure of conventional agents.
Systematic review.
PubMed and Scopus databases were systematically searched up to 28 May 2022, with additional manual search on the Google Scholar and review of the reference lists of the relevant studies to identify all published studies. Cohort studies, case series, and interventional studies written in English which evaluated the efficacy and safety of IC epinephrine in patients with no-flow phenomenon were included in our review.
Six of the 646 articles identified in the initial search met our inclusion criteria. IC epinephrine was used either as a first-line treatment [two randomized clinical trials (RCTs)] or after the failure of conventional agents (two cohort studies and two case series) for restoring the coronary flow, mainly after primary PCI. As first-line therapy, IC epinephrine successfully restored coronary flow in over 90% of patients in both RCTs, which significantly outperformed IC adenosine (78%) but lagged behind combination of verapamil and tirofiban (100%) in this regard. In the refractory no-flow phenomenon, successful reperfusion [thrombolysis in myocardial infarction (TIMI) flow grade = 3] was achieved in three out of four patients after the administration of IC epinephrine based on the results from both case series. Their findings were confirmed by a recent cohort study that further compared IC epinephrine with IC adenosine and found significant differences between them in terms of efficacy [% TIMI flow grade 3: (69.1% 52.7%, respectively; value = 0.04)] and 1-year major adverse cardiac event (MACE) outcomes (11.3% 26.7%, respectively; value ⩽ 0.01). Overall, malignant ventricular arrhythmias were reported in none of the patients treated with IC epinephrine.
Results from available evidence suggest that IC epinephrine might be an effective and safe agent in managing the no-reflow phenomenon.
目前，尚无药物或器械干预措施被充分证明能逆转无复流现象。
评估冠状动脉内（IC）肾上腺素在经皮冠状动脉介入治疗（PCI）后无复流现象管理中的疗效和安全性，无论是作为一线治疗还是在常规药物治疗失败后。
系统评价。
系统检索了 PubMed 和 Scopus 数据库，截至 2022 年 5 月 28 日，并在 Google Scholar 上进行了额外的手动搜索，以及对相关研究的参考文献进行了综述，以确定所有已发表的研究。本综述纳入了评估 IC 肾上腺素在无复流现象患者中疗效和安全性的英文发表的队列研究、病例系列和介入研究。
最初搜索中确定的 646 篇文章中有 6 篇符合我们的纳入标准。IC 肾上腺素的使用要么作为一线治疗[两项随机临床试验（RCT）]，要么在常规药物治疗失败后（两项队列研究和两项病例系列研究）用于恢复冠状动脉血流，主要是在急诊 PCI 后。作为一线治疗，两项 RCT 中 IC 肾上腺素均成功恢复了超过 90%的患者的冠状动脉血流，显著优于 IC 腺苷（78%），但在这方面落后于维拉帕米和替罗非班联合治疗（100%）。在难治性无复流现象中，基于两项病例系列研究的结果，四例患者中有三例在给予 IC 肾上腺素后成功再灌注[心肌梗死溶栓治疗（TIMI）血流分级=3]。最近的一项队列研究进一步比较了 IC 肾上腺素与 IC 腺苷，在疗效[TIMI 血流分级 3 的百分比：（69.1%比 52.7%，分别；值=0.04）]和 1 年主要不良心脏事件（MACE）结局[（11.3%比 26.7%，分别；值 ⩽ 0.01）]方面存在显著差异，证实了这一发现。总的来说，接受 IC 肾上腺素治疗的患者均未报告恶性室性心律失常。
现有证据结果表明，IC 肾上腺素可能是治疗无复流现象的一种有效且安全的药物。
