ATTENUATION OF THE NO-REFLOW PHENOMENON AFTER CORONARY ANGIOPLASTY FOR ACUTE MYOCARDIAL-INFARCTION WITH INTRACORONARY PAPAVERINE

The no-reflow phenomenon is observed as reduction of coronary blood fl ow on the angiograms (angiographic no-reflow) after immediate percutan eous transluminal coronary angioplasty (PTCA) in patients with acute m yocardial infarction (AMI). To assess whether a potent coronary microv ascular dilator-papaverine-could attenuate the no-reflow phenomenon, n ine patients with AMI who were found to have angiographic no-reflow af ter PTCA were studied. Angiographic no-reflow was defined as the Throm bolysis in Myocardial Infarction flow grade 1 or 2 without any mechani cal obstructions in the epicardial artery. A bolus dose of 10 mg of in tracoronary papaverine was administered, and the flow grade was again evaluated. Intracoronary papaverine caused a significant improvement o f the flow grade (p = 0.0152). The number of cineframes that were requ ired for the contrast medium to pass two selected landmarks on the ang iograms also significantly decreased (41 +/- 17 frames to 18 +/- 8 fra mes, p = 0.0039). Thus intracoronary papaverine attenuated angiographi c no-reflow that occurred after PTCA for AMI.