Coronary disease & ACSMeta-analysis
Intracoronary Vasoactive Therapy for No-Reflow During Primary PCI
- systematic review and frequentist network meta-analysis of randomized controlled trials
Authors' conclusion
In this network meta-analysis, intracoronary verapamil and epinephrine were associated with improvements in final TIMI flow grade 3 compared with control. Further studies are needed to clarify optimal agent selection.
Study context
- Population
- Patients with the no-reflow phenomenon during primary percutaneous coronary intervention
- Participants
- 1,674 Thirteen studies
- Comparison
- intracoronary adenosine, epinephrine, nitroprusside, and verapamil administered during primary percutaneous coronary intervention for the treatment of the no-reflow phenomenon, compared with control
- Outcome
- restoration of TIMI flow grade 3 flow
- Follow-up
- At the end of the procedure
Pooled result
As reported in the abstract
Each group vs controlOdds ratio (95% CI)
epinephrine
2.81(1.72–4.58)
verapamil
2.84(1.63–4.95)
Further pooled results
| Outcome | OR (95% CI) | |
|---|---|---|
| ST-segment resolution — epinephrine vs control · τ2 = 0; I2 = 0% | 4.30 (2.19–8.45) | |
| ST-segment resolution — verapamil vs control · τ2 = 0; I2 = 0% | 2.85 (1.64–4.96) | |
| ST-segment resolution — adenosine vs control · τ2 = 0; I2 = 0% | 1.38 (1.04–1.84) | |
| 0.10.31310Odds ratio (log scale) |
major adverse cardiovascular events and all-cause mortality
- None of the therapies reduced major adverse cardiovascular events or mortality
- the analysis was underpowered
Original publication
Intracoronary Vasoactive Therapy for No-Reflow During Primary PCI. JACC Adv. Published 25 February 2026. doi:10.1016/j.jacadv.2026.102599
Summarised from the published abstract; every number is checked against it