Abstract

Background: Percutaneous coronary intervention (PCI) has significantly improved the management of acute coronary syndromes (ACS) and chronic coronary artery disease (CAD), reducing morbidity and mortality. The Thrombolysis in Myocardial Infarction (TIMI) flow grades measure the success of PCI in restoring blood flow. However, achieving optimal TIMI flow can be challenging due to complications like the no-reflow phenomenon, which occurs despite successful mechanical opening of the coronary artery and is associated with poor outcomes.
Objective: To assess the impact of intracoronary adrenaline (epinephrine) on post-PCI TIMI flow grades and associated hemodynamic effects in patients experiencing no-reflow or slow-flow phenomena during PCI.
Methods: This retrospective study was conducted at the Interventional Cardiology Department of Hayatabad Medical Complex, Peshawar, from January 1, 2023, to December 31, 2023. A total of 800 consecutive patients who underwent PCI and experienced no-reflow or slow-flow phenomena were included. Intracoronary adrenaline was administered, and data were collected on patient demographics, comorbid conditions, lesion location, TIMI flow grades, and hemodynamic parameters before and after adrenaline administration. Statistical analysis was performed using SPSS software (version 25.0), with paired Student’s t-tests and chi-square tests used for data comparison.
Results: The administration of intracoronary adrenaline resulted in a significant improvement in TIMI flow grades, with complete restoration of TIMI 3 flow in 589 (73.2%) patients. TIMI frame count decreased significantly from 57 ± 11 to 18 ± 09 (p < 0.021). TIMI myocardial blush grade improved from 0.82 ± 0.69 to 2.60 ± 0.63 (p < 0.032). Hemodynamic parameters, including systolic and diastolic blood pressures and heart rate, showed significant improvement post-adrenaline administration (p < 0.001). The incidence of non-sustained ventricular tachycardia was 27%, while sustained ventricular tachycardia was negligible. The need for intra-aortic balloon pump (IABP) and transvenous pacing was documented in 16% of cases.
Conclusion: Intracoronary adrenaline is effective in improving TIMI flow grades and hemodynamic stability in patients with refractory no-reflow following primary PCI for STEMI. The treatment was well tolerated with minimal adverse effects, suggesting its potential utility in clinical practice. However, large-scale randomized studies are needed to confirm these findings and establish guidelines for optimal dosing and administration strategies.