Intracoronary Pharmacotherapy (Verapamil-Epinephrine-Adenosine) for Prevention of No Reflow during Primary Percutaneous Coronary Intervention in Patients with ST Elevation Myocardial Infarction

Abstract

Background: When the TIMI flow is less than 3 or, in the instance of a flow of 3, when the MBG is 0 or 1, no reflow is detected (in the absence of evident vessel dissection, obstruction or distal vessel embolic cutoff). According to the TIMI flow count, the flow in the coronaries may be graded as 0 (no flow), 1 (penetration without perfusion), 2, or 3 (partial perfusion) (complete perfusion). Grade 0 indicates that there is no myocardial blush (or contrast density), while grade 1 indicates that there is continuing blush (staining) Grade 1 indicates the least amount of myocardial blush, grade 2 indicates significant myocardial blush (or contrast density), but less than that seen during angiography of a non-infarct-related coronary artery on the ipsilateral or contralateral side, and grade 3 indicates typical blush. Patients and Methods: This research included 128 individuals who had acute ST elevation myocardial infarction during the first 24 hours of experiencing symptoms and were treated at Wadi El-Nile and Ain Shams university hospitals between the years 2022 and 2023. In order to avoid STEMI patients from having no reflow during PPCI, the research compared the safety and effectiveness of intracoronary injections of epinephrine, verapamil, or adenosine against the control group. Aiming to evaluate TIMI flow grade, MBG, TIMI thrombus grade, ST segment resolution >70%, occurrence of no reflow, EF, LV diameters, and MACE status within 3 months, the study was conducted through 4 groups: group 1 received epinephrine, group 2 received adenosine, group 3 received verapamil, and group 4 did not receive pretreatment. Results: The epinephrine group, followed by the verapamil group, followed by the adenosine group, followed by the control group, had the best TIMI flow grade and MBG scores. After taking the medicines, there was no significant difference in the TIMI thrombus grade across the 4 groups. ST segment resolution varied quantitatively across the 4 groups, but there was no statistically significant difference. The three drugs—Epinephrine, Verapamil, and Adenosine—were all more successful than the control group when it came to preventing no reflow than they were individually. Between the 4 groups, there was no statistically significant difference in the EF and LV diameters. Within a 3-month period, there was no difference in the MACE status across the 4 groups. Conclusion: According to the available data, epinephrine, verapamil, and adenosine are safe and efficient in avoiding no-reflow in patients with ST Elevation Myocardial Infarction during PPCI, with epinephrine performing best, followed by verapamil, then adenosine. To verify these results, more research with a bigger sample size and a longer follow-up period is needed.