Comparison of combination therapy of adenosine and nitroprusside with adenosine alone in the treatment of angiographic no‐reflow phenomenon

Abstract

We sought to compare the combination therapy of adenosine and nitroprusside in no-reflow phenomenon during percutaneous coronary intervention. Improvement in coronary flow from no-reflow to postdrug state was evaluated. Patients who received adenosine (n = 21) were compared to ones who received the combination of adenosine and nitroprusside (n = 20) for treatment. Improvement of TIMI flow grades was higher in the group that received combined therapy (1.5 +/- 1.0 vs. 0.8 +/- 0.6; P < 0.05). Combination therapy of adenosine and nitroprusside is safe and provides better improvement in coronary flow compared to intracoronary adenosine alone in case of impaired flow during coronary interventions.

2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention

“…Presently, the modified ACC/AHA score 230 and the SCAI score (Appendix 4B) 237 are both in use, with the latter slightly outperforming the former. Discrimination as measured by the C statistic is generally good to very good (0.70 to 0.82), depending on the outcome variable and patient population.…”

“…These include adenosine, calcium channel blockers, and nitroprusside. 676,678,679,681,684,686,689,691 There are fewer data to support the use of epinephrine. 692 No-reflow after rotational atherectomy was less common with nicorandil compared with verapamil infusions in 3 studies, [693][694][695] and an infusion of nicorandil/adenosine during rotational atherectomy prevented no-reflow in 98% of patients.…”

2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention

“…Administration of an intracoronary vasodilator (adenosine, calcium channel blocker, or nitroprusside) is reasonable to treat PCI-related no-reflow that occurs during primary or elective PCI (674)(675)(676)(677)(678)(679)(680)(681)(682)(683)(684)(685)(686)(687)(688)(689).…”

Intracoronary pharmacotherapy in the management of coronary microvascular dysfunction

“…In the setting of refractory no reflow, a combination of adenosine and nitroprusside may be effective. Barcin et al [40] demonstrated that the combined use of IC adenosine (18-36 lg) and nitroprusside (50-200 lg) in angiographic no reflow phenomenon during PCI is safe and potentially more effective than adenosine alone.…”