FREQUENCY OF NO-REFLOW IN PATIENTS UNDERGOING PRIMARY PERCUTANEOUS CORONARY INTERVENTION AND THE IMPACT OF INTRACORONARY ADRENALINE AND TIROFIBAN ON TIMI FLOW

Authors

  • Ikram Ullah Department of Cardiology, Lady Reading Hospital Peshawar-Pakistan
  • Hamidullah Department of Cardiology, Lady Reading Hospital Peshawar-Pakistan
  • Farooq Ahmad Department of Cardiology, Khyber Teaching Hospital Peshawar-Pakistan
  • Sajjad Khan Department of Cardiology, Lady reading Hospital Peshawar-Pakistan
  • Hafiz Adil Bilal Department of Cardiology, Lady reading Hospital Peshawar-Pakistan
  • Samiurehman Department of Cardiology, Lady reading Hospital Peshawar-Pakistan

Keywords:

Key words. STEMI, no reflow, TIMI, PPCI

Abstract

Background: Coronary interventions, including percutaneous coronary intervention (PCI), have significantly improved management of coronary artery disease by restoration of coronary blood flow to myocardium. However, despite of so many advancements in PCI procedural techniques, there is still a significant and challenging complication known as the "no-reflow" phenomenon exists which worstly effect the PPCI outcome. Methods: It was Cross sectional study conducted at Department of Cardiology, Lady Reading Hospital Peshawar. Study was conducted from 1/1/2023 to 30/6/2023 for six months. All patients who developed no reflow were subjected to intracoronary Tirofiban. Those who do not responded to Tirofiban were given intracoronary adrenalin and effect was noted. Data were analyzed using SPSS Version 23.0. Mean and standard deviation were calculated for quantitative variables like age. Frequencies and percentages were calculated for categorical variables like gender. The p-value less than 0.05 was considered significant. Results: Among 151 participants, 18% experienced the no-reflow phenomenon. Intracoronary adrenaline and Tirofiban individually showed a significant positive impact on TIMI flow. It was found that 40% patients with no reflow responded to Tirofiban administration. Remaining patients with no reflow were subjected to intracoronary adrenalin therapy and 74% of these patients had improved TIMI flow. It was also found that combine effect of Tirofiban and adrenalin was found in 84% of patients. Conclusion: No reflow phenomenon is common finding in Primary PCI and can be effectively managed by Tirofiban and intracoronary adrenalin administration in most cases.

Author Biography

Ikram Ullah, Department of Cardiology, Lady Reading Hospital Peshawar-Pakistan

junior registrar cardio vascular lady reading hospital peshawar

References

Kocayigit I, Yaylaci S, Osken A, Aydın E, Sahinkus S, Can Y, et al. Comparison of effects of thrombolytic therapy and primary percutaneous coronary intervention in elderly patients with acute ST-segment elevation myocardial infarction on in-hospital, six-month, and one-year mortality. Arch Med Sci Atheroscler Dis 2019;4:e82–8.

Mehta RH, Parsons L, Rao SV, Peterson ED. National Reg-istry of Myocardial Infarction (NRMI) Investigators. Association of bleeding and in-hospital mortality in black and white patients with ST-segment elevation myocardial infarction receiving reperfusion. Circulation 2012;125(14):1727–34.

Yeh RW, Sidney S, Chandra M, Sorel M, Selby JV, Go AS. Population trends in the incidence and outcomes of acute myocardial infarction. N Engl J Med 2010;362(23):2155–65.

Terkelsen CJ, Sørensen JT, Maeng M, Jensen LO, Tilsted HH, Vach W, et al. System de-lay and mortality among patients with STEMI treated with primary percutaneous coronary intervention. JAMA 2010;304(7):763–71.

Armstrong PW, Boden WE. Reperfusion paradox in ST-segment elevation myocardial infarction. Ann Intern Med 2011;155(6):389–91.

Yudi MB, Sharma SK, Tang GHL, Kini A. Coronary angiography and percutaneous coronary intervention after transcatheter aortic valve replacement. J Am Coll Cardiol 2018;71(12):1360–78.

Jaffe R, Charron T, Puley G, Dick A, Strauss BH. Microvascular obstruction and the no-reflow phenomenon after percutaneous coronary intervention. Circulation 2008;117(24):3152–6.

Galasso G, Schiekofer S, D'Anna C, Gioia GD, Piccolo R, Niglio T, et al. No-reflow phenomenon: pathophysiology, diagnosis, prevention, and treatment. A review of the current literature and future perspectives. Angiology 2014;65(3):180–9.

Reffelmann T, Kloner RA. Kloner, The “no-reflow” phenomenon: basic science and clinical correlates. Heart 2002;87(2):162–8.

Kelly RV, Cohen MG, Runge MS, Stouffer GA. The no-reflow phenomenon in coronary arteries. J Thromb Haemost 2004;2(11):1903–7.

Ito H. No-reflow phenomenon and prognosis in patients with acute myocardial infarction. Nat Clin Pract Cardiovasc Med 2006;3(9):499–506.

Jaffe R, Charron T, Puley G, Dick A, Strauss BH. Microvascular obstruction and the no-reflow phenomenon after percutaneous coronary intervention. Circulation 2008;117(24):3152–6.

Wang L, Cheng Z, Gu Y, Peng D. Short-term effects of verapamil and diltiazem in the treatment of no reflow phenomenon: a meta-analysis of randomized controlled trials. Biomed Res Int 2015;2015:382086.

Arab TA, Rafik R, Etriby AL. Efficacy and safety of local intracoronary drug delivery in treatment of no-reflow phenomenon: a pilot study. J Interven Cardiol 2016;29(5):496–504.

Rao PS. Bhardwaj R, .Negi PC, Nath RK. No reflow phenomenon in CAD patients after percutaneous coronary intervention: A prospective hospital based observational study. Indian Heart J 2023;75(2):156–9.

Yang L, Cong H, Lu Y, Chen X, Liu Y. Prediction of no-reflow phenomenon in patients treated with primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Medicine (Baltimore) 2020;99(26):e20152.

Shahri BM. Vojdanparast, Coronary No-reflow Phenomenon: A Review of Therapeutic Pharmacological Agents. Razavi Int J Med 2020;8(1234):1–7.

Akpek M, Sahin O, Sarli B, Baktir AO, Saglam H, Urkmez S, et al. Acute Effects of Intracoronary Tirofiban on No-Reflow Phenomena in Patients With ST-Segment Elevated Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Angiology 2015;66(6):560–7.

Aksu T, Guler TE, Colak A, Baysal E, Durukan M, Sen T, et al. Intracoronary epinephrine in the treatment of refractory no-reflow after primary percutaneous coronary intervention: a retrospective study. BMC Cardiovasc Disord 2015;15:10.

Published

2024-09-08

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