title: Resolution of refractory no-reflow with intracoronary epinephrine.
abstract: Refractory no-reflow is associated with adverse outcomes in patients undergoing percutaneous coronary intervention. Charts were reviewed to identify 29 consecutive patients in whom intracoronary epinephrine was administered for refractory no-reflow. The effects of intracoronary epinephrine on coronary flow (TIMI grade), cardiac rhythm, and systolic blood pressure in the cardiac catheterization laboratory were assessed. Administration of intracoronary epinephrine (mean dose, 139 +/- 189 microg) resulted in significant improvement in coronary flow. After administration, TIMI 3 flow was established in 69% of patients. Overall, TIMI flow significantly increased (mean TIMI flow form 1.0 +/- 1.0 to 2.66 +/- 0.55; P = 0.0001). Intracoronary epinephrine resulted in significant but tolerable increase in heart rate (72 +/- 19 to 86 +/- 26 beats/min; P = 0.009), but no cases of acute dysrhythmia. These findings indicate that intracoronary epinephrine may exert salutary effects in patients suffering refractory no-reflow following elective or acute coronary interventions.
authors.affiliation: Division of Cardiology, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Skelding
authors.forename: James A
authors.initials: JA
authors.lastname: Goldstein
authors.forename: Laxmi
authors.initials: L
authors.lastname: Mehta
authors.forename: Mark C
authors.initials: MC
authors.lastname: Pica
authors.forename: William W
authors.initials: WW
authors.lastname: O'Neill
mesh_terms: D000077284:Abciximab; D000208:Acute Disease; D015906:Angioplasty, Balloon, Coronary; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D001783:Blood Flow Velocity / Q000187:drug effects* / Q000502:physiology*; D001794:Blood Pressure / Q000187:drug effects; D003131:Combined Modality Therapy; D003326:Coronary Circulation / Q000187:drug effects* / Q000502:physiology*; D003327:Coronary Disease / Q000503:physiopathology / Q000628:therapy; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D004837:Epinephrine / Q000008:administration & dosage*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D007423:Intra-Aortic Balloon Pumping; D008824:Michigan; D005996:Nitroglycerin / Q000627:therapeutic use; D012189:Retrospective Studies; D013577:Syndrome; D013599:Systole / Q000187:drug effects; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*; D014665:Vasodilator Agents / Q000627:therapeutic use; D014700:Verapamil / Q000627:therapeutic use
chemical_list: D000911:Antibodies, Monoclonal; D000925:Anticoagulants; D007140:Immunoglobulin Fab Fragments; D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents; D014700:Verapamil; D005996:Nitroglycerin; D000077284:Abciximab; D004837:Epinephrine