Back to the flow: a comprehensive systematic review and meta-analysis of epinephrine in the treatment of no-reflow.
Leonardo Dexheimer da Silva, Leonardo Cadorin de Araújo, Eduarda Dexheimer da Silva et al.
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In 30 seconds
This systematic review and meta-analysis assessed intracoronary epinephrine for treating or preventing no-reflow after coronary recanalization, drawing on 11 studies with 700 epinephrine-treated and 298 control patients. In single-arm analyses, TIMI 3 flow was achieved in 63% of refractory and 86% of primary no-reflow cases. Compared with conventional treatment, epinephrine was associated with lower MACE risk (risk ratio 0.45; 95% confidence interval: 0.23-0.87; P = 0.01; I2 = 0%), but no difference was found versus adenosine. The authors describe the findings as exploratory.
Key findings
- TIMI 3 flow was achieved in 63% of refractory and 86% of primary no-reflow cases.
- Myocardial blush grade 3 was achieved in 47.4% of cases.
- Compared with conventional treatment, epinephrine was associated with lower MACE risk (risk ratio 0.45; 95% confidence interval: 0.23-0.87; P = 0.01; I2 = 0%).
- MACE incidence was 14% in refractory and 18% in primary no-reflow; epinephrine showed no MACE difference versus adenosine.
Why it matters
No-reflow can compromise myocardial reperfusion despite successful epicardial recanalization and is associated with adverse outcomes. These pooled findings suggest intracoronary epinephrine may improve flow and may compare favourably with conventional treatment for MACE, while the absence of a difference versus adenosine and the exploratory nature of the evidence leave its comparative role uncertain.
What to keep in mind
The evidence was based on 11 studies and was described by the authors as limited and heterogeneous. TIMI flow results came from single-arm meta-analyses, limiting comparative interpretation.