Intracoronary Vasoactive Therapy for No-Reflow During Primary PCI

BACKGROUND: The no-reflow phenomenon frequently complicates primary percutaneous coronary intervention and is associated with adverse outcomes. Evidence supporting a specific pharmacological treatment is limited. OBJECTIVES: The aim of this study was to compare commonly used intracoronary medications for the treatment of the no-reflow phenomenon. METHODS: We performed a systematic review and frequentist network meta-analysis of randomized controlled trials comparing intracoronary adenosine, epinephrine, nitroprusside, and verapamil administered during primary percutaneous coronary intervention for the treatment of the no-reflow phenomenon (PROSPERO CRD420251102877). The primary efficacy endpoint was restoration of TIMI flow grade 3 flow at the end of the procedure. Secondary endpoints included ST-segment resolution, major adverse cardiovascular events, and all-cause mortality. RESULTS: = 0%). None of the therapies reduced major adverse cardiovascular events or mortality, although the analysis was underpowered. CONCLUSIONS: 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.