Pharmaceutical Interventions for the Management of No-Reflow

Tim A. Fischell, MD

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

In This Article


Nicorandil has specific vasodilating effects mediated through effects on adenosine triphosphate-sensitive potassium channels and may impede the formation of radical oxygen species.[54,55] Intravenous infusion showed benefit compared with placebo in reducing the incidence of no-reflow in 33 patients undergoing PCI for AMI.[55] IC administration of nicorandil in combination with adenosine for no-reflow was associated with statistically significant improvements compared with adenosine alone. Improvements were demonstrated for TIMI flow grade (2.0 ± 0.9 vs. 2.6 ± 0.6, p = 0.024) and change in TFC before and after PCI (45.2 ± 24.5 vs. 63.6 ± 23.2, p = 0.014).56 IC nicorandil was more effective than IC verapamil in preventing no-reflow in 61 patients (63 lesions) undergoing rotational atherectomy. No- or slow-reflow was observed in 11/63 (17.5%) lesions among verapamil-treated subjects, compared with 1/37 (2.7%) lesions in the nicorandil group (p = 0.03).[57]


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