Efficacy and safety of intracoronary epinephrine versus conventional treatments alone in STEMI patients with refractory coronary no-reflow during primary PCI: The RESTORE observational study.

Journal Article (Journal Article)

OBJECTIVES: We aimed to compare intracoronary (IC) epinephrine versus conventional treatments alone in patients with ST-elevation myocardial infarction and refractory coronary no-reflow during primary percutaneous coronary intervention (PPCI). METHODS: Thirty consecutive patients with severe refractory coronary no-reflow (TIMI 0-1, MBG 0-1) during PPCI were prospectively included after initial failure of conventional treatments. Conventional treatments used in both groups included IC nitrates, thrombectomy. Glycoprotein IIb/IIIa inhibitors and adenosine. Patients received IC epinephrine or no epinephrine. RESULTS: Intracoronary administration of epinephrine yielded significantly better coronary flow patterns (28.6% TIMI 3, 64.3% TIMI 2, 7.1% TIMI 1, and 0% TIMI 0), compared to those after treatment with conventional agents alone (18.8% TIMI 3, 12.5% TIMI 2, 37.5% TIMI 1, and 31.3% TIMI 0) (p value between groups = .004). In the IC epinephrine vs. no epinephrine group there was a significant reduction of 30-day composite of death or heart failure (35.7% vs. 81.25%), improvement of ejection fraction (p = .01) and ST-segment resolution (p = .01). CONCLUSIONS: The findings of this proof-of-concept study suggest that as compared to use of conventional agents alone, IC epinephrine provides substantial improvement of coronary flow in STEMI patients with refractory no-reflow during PPCI that may result into improved prognosis.

Full Text

Duke Authors

Cited Authors

  • Navarese, EP; Frediani, L; Kandzari, DE; Caiazzo, G; Cenname, AM; Cortese, B; Piva, T; Muçaj, A; Tumscitz, C; Paparoni, F; Larosa, C; Bisceglia, T; Menozzi, M; Gurbel, PA; Kubica, J

Published Date

  • March 2021

Published In

Volume / Issue

  • 97 / 4

Start / End Page

  • 602 - 611

PubMed ID

  • 32678493

Electronic International Standard Serial Number (EISSN)

  • 1522-726X

Digital Object Identifier (DOI)

  • 10.1002/ccd.29113


  • eng

Conference Location

  • United States