Pharmaceutical Interventions for the Management of No-Reflow

Tim A. Fischell, MD

J Invasive Cardiol. 2008;20(7):374-379. 

In This Article

Nicardipine

Nicardipine possesses a number of attributes suggesting particular utility for reversal and/or prevention of no-reflow.[49] It is a dihydropyridine calcium-channel antagonist with relatively selective coronary vascular effects, producing a marked increase in coronary blood flow in vascular smooth muscle with minimal direct myocardial depressant activity.[50,51] In a comparative study with IC diltiazem or verapamil, IC nicardipine achieved significantly more prolonged coronary vasodilation and a significantly greater mean increase over baseline coronary flow velocity than either nondihydropyridine.[52]

In a retrospective study, IC nicardipine successfully reversed no-reflow associated with PCI of native vessels or grafts and restored TIMI 3 flow in 71/72 patients.[53] TIMI flow grade pre- and post-treatment was 1.65 ± 0.53 and 2.97 ± 0.24, respectively (p <0.001), while frame counts decreased from 57 ± 40 at the time of no-reflow to 15 ± 12 after nicardipine (p <0.001). More recently, prophylactic intragraft nicardipine followed immediately by direct stenting of SVGs without mechanical distal protection in a series of 68 elective patients dramatically reduced the incidence of no-reflow. Transient no-reflow was observed in 2/83 graft interventions (2.4%), an incidence comparable to elective interventions in native vessels. The overall rate of 30-day major adverse cardiac events in this study was at least as low as historical data from trials evaluating different mechanical distal protection systems, suggesting a potential pharmacologic alternative or adjunct to mechanical distal protection.[31]

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.

processing....