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Intracoronary verapamil vs. intracoronary epinephrine in the management of coronary no reflow during primary percutaneous coronary intervention

Mohamed Saber Hafez, Ahmed Rafek Ghazawy, Mohamed El Sayed Zahran

Background: Coronary No-Reflow (CNR) is one of the common and life-threatening complications that occurs during Primary Percutaneous Coronary Intervention (PPCI) in the setting of acute ST Elevation Myocardial Infarction (STEMI). Rapid restoration of myocardial perfusion is a major challenge during this condition in order to reduce morbidity and mortality. Unfortunately, the best treatment of CNR is still unknown.

Aim: To compare between the efficacy of intracoronary verapamil and intracoronary epinephrine in the treatment of coronary no-reflow during PPCI for STEMI patients versus standard therapy (Glycoprotein IIb/IIIa inhibitors).

Methodology: This study was a prospective clinical trial in which 150 patients were included and randomly divided into three groups (verapamil, adrenaline and control-intracoronary Glycoprotein IIb/IIIA inhibitors). Immediate outcome was noted (Thrombolysis in Myocardial Infarction (TIMI) flow grade and Myocardial Blush Grade (MBG)) as well as short term outcome (Rise in Left Ventricular Ejection Fraction (LVEF) after 3 months from the index event).

Results: Verapamil and Control groups achieved better TIMI flow (100%) than adrenaline group (92%). Intracoronary verapamil led to significantly better MBG (grade 2 or 3 in 60% of cases) compared to 38% in adrenaline group and 46% in control group and rise in LVEF was significantly higher in verapamil group (mean rise=19.6%).

Conclusion: Intracoronary verapamil injection is better than intracoronary adrenaline and intracoronary Glycoprotein II/IIIa inhibitors in the reversal of CNR during PPCI and in the improvement of LVEF at three months follow up.