Abstract
Despite modern advances in performing percutaneous coronary interventions, refractory no-reflow remains a serious problem that worsens in-hospital and long-term prognosis. Low-dose adrenaline may exhibit potent beta-receptor agonist properties that mediate coronary vasodilation.Aim. To evaluate the efficacy and safety of intracoronary administration of epinephrine and verapamil, as well as their combination, compared with standard treatment in patients with ST-segment elevation myocardial infarction (STEMI) and refractory no-reflow during percutaneous coronary interventions.Material and methods. Patients with STEMI and refractory no-reflow will be randomized into 4 groups: standard therapy, intracoronary adrenaline, intracoronary verapamil, intracoronary epinephrine + verapamil. All patients will be assessed for epicardial blood flow using the Thrombolysis in Myocardial Infarction (TIMI) and Myocardial Blush Grade (MBG) scales, peak troponin levels, ST segment changes, echocardiography, magnetic roesnance imaging, and dynamic single photon emission computed tomography.Results. Based on the pharmacodynamic effects of epinephrine and verapamil, their combination is expected to have a more potent vasodilating effect.Conclusion. If the Intracoronary administration of EPInephrine and VERapamil in the refractory no-reflow phenomenon (EPIVER) study will be successful, a novel, more effective method for managing refractory no-reflow phenomenon will appear. This will ensure better preservation of left ventricular systolic function, as well as improve the prognosis and clinical course of the disease.
Highlights
Current guidelines support the choice of percu taneous coronary intervention (PCI) as the preferred reperfusion strategy in patients with acute ST — segment elevation myocardial infarction (STEMI) [1, 2]
No-ref low syndrome may negate the benefits of early restoration of culprit artery patency, which translates into the suboptimal PCI results, leading to a worse in-hospital and long-term prognosis [3]
In 2002, a study was conducted, in which 29 patients with no-ref low phenomenon were injected with intracoronary adrenaline, which led to a significant improvement in coronary blood flow and the achievement of TIMI 3 (Thrombolysis in Myocardial Infarction) in 69% of cases [10]
Summary
Current guidelines support the choice of percu taneous coronary intervention (PCI) as the preferred reperfusion strategy in patients with acute ST — segment elevation myocardial infarction (STEMI) [1, 2]. Nitrates, ade nosine, platelet IIb/IIIa receptor inhibitors and throm boextraction can be used to prevent and treat this complication These methods have demonstrated the ability to improve coronary blood f low in experiment and small clinical trials [4, 5], limiting the zone of myocardial necrosis and improving disease outcomes have not been achieved [6,7,8]. In 2002, a study was conducted, in which 29 patients with no-ref low phenomenon were injected with intracoronary adrenaline, which led to a significant improvement in coronary blood flow and the achievement of TIMI 3 (Thrombolysis in Myocardial Infarction) in 69% of cases [10]. Present trial aims to estimate the efficacy and safety of intracoronary (IC) epinephrine and verapamil administration, as well as their combination versus standard treatment in patients with STEMI and refractory coronary no-ref low despite conventional treatments during PCI
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