Back to the flow: a comprehensive systematic review and meta-analysis of epinephrine in the treatment of no-reflow.

IF 2.2 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Coronary artery disease Pub Date : 2026-11-01 Epub Date: 2026-03-23 DOI:10.1097/MCA.0000000000001632

Leonardo Dexheimer da Silva, Leonardo Cadorin de Araújo, Eduarda Dexheimer da Silva, Kauã Gabriel Oliveira, Ricardo Fonseca Oliveira Suruagy-Motta, Miguel Rodrigues Moreira, Gabriel Rezende Neves, Carlos Alexandre Farias, Leonardo Galvão de Oliveira Oldra, Pedro Antonio Machado Gomes de Sousa, Pedro Augusto Bento de Sousa, Felipe da Silva Ribeiro, Guilherme Sobreira Spina, Kalgi Modi

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引用次数: 0

Abstract

Purpose: The no-reflow phenomenon is defined as inadequate microvascular reperfusion despite successful epicardial coronary recanalization, associated with multiple adverse outcomes, occurring in up to 7% of primary PCI. Its multifactorial pathophysiology includes endothelial injury, distal embolization, and vasospasm. Thus, intracoronary epinephrine has shown promising results due to its vascular regulation. Then, this meta-analysis evaluates the role of epinephrine to treat and prevent the no-reflow phenomenon.

Methods: Following Preferred reporting Items for Systematic Reviews and Meta-Analysis standards, we systematically searched MEDLINE, Scopus, Embase, Cochrane, and Web of Science for studies comparing epinephrine with conventional therapy or other drugs. The primary outcome was thrombolysis in myocardial infarction (TIMI) flow. Secondary outcomes included major adverse cardiovascular events (MACE), heart failure, mortality, left ventricular ejection fraction, and myocardial blush grade.

Results: Eleven studies (700 epinephrine, 298 control) were included. TIMI flow was assessed using single-arm meta-analyses, stratified into refractory and primary no-reflow. TIMI 3 flow was achieved in 63% of refractory and 86% of primary. Myocardial blush grade 3 was achieved in 47.4% of cases. MACE incidence was 14% in refractory and 18% in primary no-reflow. Compared with conventional treatment, epinephrine reduced MACE risk (risk ratio 0.45; 95% confidence interval: 0.23-0.87; P = 0.01; I2 = 0%) but showed no difference versus adenosine. Heart failure incidence was 11% in controls and 5% in adenosine, without significant comparative differences.

Conclusion: Therefore, intracoronary epinephrine was associated with encouraging but exploratory findings, and the higher success rate in primary no-reflow may reflect earlier intervention and less severe microvascular damage. Its modest advantage over adenosine suggests potential therapeutic value, though evidence remains limited and heterogeneous.

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回到血流：肾上腺素治疗无血流的综合系统回顾和荟萃分析。

目的：无回流现象被定义为尽管心外膜冠状动脉再通成功，微血管再灌注不足，与多种不良后果相关，在首次PCI中发生率高达7%。其多因素病理生理包括内皮损伤、远端栓塞和血管痉挛。因此，冠状动脉内肾上腺素由于其血管调节作用而显示出良好的效果。然后，本荟萃分析评估肾上腺素在治疗和预防无血流现象中的作用。方法：根据系统评价和meta分析标准的首选报告项目，我们系统地检索MEDLINE、Scopus、Embase、Cochrane和Web of Science，以比较肾上腺素与常规治疗或其他药物的研究。主要终点是心肌梗死（TIMI）血流溶栓。次要结局包括主要不良心血管事件（MACE）、心力衰竭、死亡率、左心室射血分数和心肌红晕等级。结果：纳入11项研究（肾上腺素700项，对照组298项）。使用单臂荟萃分析评估TIMI流量，分为难治性和原发性无血流。63%的难治性患者和86%的原发性患者实现了timi3流动。47.4%的患者心肌红肿达到3级。难治性MACE发生率为14%，原发性无回流组为18%。与常规治疗相比，肾上腺素降低MACE风险（风险比0.45；95%可信区间：0.23-0.87;P = 0.01; I2 = 0%），但与腺苷无差异。对照组的心力衰竭发生率为11%，腺苷组为5%，没有显著的比较差异。结论：因此，冠状动脉内肾上腺素与令人鼓舞但探索性的发现有关，原发性无血流灌注的成功率较高可能反映了早期干预和较轻的微血管损伤。它相对于腺苷的适度优势提示了潜在的治疗价值，尽管证据仍然有限且不一致。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Coronary artery disease 医学-外周血管病

CiteScore

2.50

自引率

0.00%

发文量

190

审稿时长

6-12 weeks

期刊介绍： Coronary Artery Disease welcomes reports of original research with a clinical emphasis, including observational studies, clinical trials, translational research, novel imaging, pharmacology and interventional approaches as well as advances in laboratory research that contribute to the understanding of coronary artery disease. Each issue of Coronary Artery Disease is divided into four areas of focus: Original Research articles, Review in Depth articles by leading experts in the field, Editorials and Images in Coronary Artery Disease. The Editorials will comment on selected original research published in each issue of Coronary Artery Disease, as well as highlight controversies in coronary artery disease understanding and management. Submitted artcles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.