Safety and Efficacy of Intracoronary Vasodilators in the Treatment of No-Reflow after Primary Percutaneous Intervention in Patients with Acute ST-Elevation Myocardial Infarction: A Literature Review

Document Type: Review Article


Department of Cardiology, Quaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.


Introduction: The investigation of no-reflow phenomenon after Percutaneous Coronary Intervention (PCI) in patients with acute ST-segment Elevation Myocardial Infarction (STEMI) has therapeutic implications. Several vasodilators were administered through intracoronary injection to treat this phenomenon. We aimed to elucidate the risk factors, predictors, and long-term effects of no-reflow phenomenon, and to compare the effects of various vasodilators on re-opening the obstructed vessels. 
Materials and Methods: All the reviewed articles were retrieved from MEDLINE and Science Direct (up to October 2014). All no-reflow cases were determined through Thrombolysis in Myocardial Infarction grading (TIMI) system. 
Results: Four articles were included, two of which mainly focused on risk factors, predictors, and long-term prognosis of no-reflow phenomenon, and its association with patient mortality and morbidity. The other two articles evaluated therapeutic interventions and compared their efficacy in treating no-reflow. 
Conclusion: Development of no-reflow in patients with STEMI after primary PCI is associated with low myocardial salvage by primary PCI, large scintigraphic infarct size, deteriorated left ventricle ejection fraction at six months, and increased risk of first-year mortality. During primary PCI, intracoronary infusion of diltiazem and verapamil can reverse no-reflow more effectively than nitroglycerin.