Coronary artery disease · 2026
Back to the flow: a comprehensive systematic review and meta-analysis of epinephrine in the treatment of no-reflow.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
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Dexheimer da Silva Leonardo, de Araújo Leonardo Cadorin, Dexheimer da Silva Eduarda, Oliveira Kauã Gabriel, Suruagy-Motta Ricardo Fonseca Oliveira, Moreira Miguel Rodrigues, Neves Gabriel Rezende, Farias Carlos Alexandre, de Oliveira Oldra Leonardo Galvão, de Sousa Pedro Antonio Machado Gomes, de Sousa Pedro Augusto Bento, da Silva Ribeiro Felipe, Spina Guilherme Sobreira, Modi Kalgi
Аннотация
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.
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.