Table 2.
Main findings of included studies.
| Article | Comparison | Method of administration | Outcomes | Comparison of Outcomes | Qualitative assessment | |||
|---|---|---|---|---|---|---|---|---|
| Findings | Conclusion | |||||||
| First-line treatment of no-reflow | Khan et al.6 | EPI versus ADN | Intracoronary, 88% proximal via guide wire and 12% distal via device | In-hospital | TFG = 3 | 90.1% versus 78.0%* | Pos. | • EPI > ADN: • Efficacy ↑ • No case of VF in Epi group |
| cTFC | 24 ± 8.43 versus 26.63 ± 9.22* | Pos. | ||||||
| MBG 3 | 55.4% versus 45% | Pos. | ||||||
| HF | 19.8% versus 19.0% | ~ | ||||||
| Death | 3.0% versus 2.0% | ~ | ||||||
| MACE | 38.8% versus 41.0%* | Pos. | ||||||
| Follow-up 30 days |
HF | 18.3 versus 13.5 | Pos. | |||||
| Death | 7.1 versus 5.2 | ~ | ||||||
| MACE | 20.3 versus 25.9 | Pos. | ||||||
| Hafez et al.11 | EPI versus VRP versus GPI | Intracoronary, distal to the lesion using self-made holes in a semi-compliant balloon | In-hospital | TFG = 3 | 92% versus 100% versus 100%* | Neg. | • EPI < VRE and GPI: • Efficacy ↑ |
|
| MBG 2–3 | 38% versus 60% versus 46%* | Neg. | ||||||
| Follow-up 3 months |
EF [mean% of change (SD)] | 9.18 (16.51) versus 19.6 (29.4) versus 10.11 (10.73)* | Neg. | |||||
| Refractory no- reflow | Navarese et al.9 | EPI versus no-EPI | Intracoronary, proximal using guiding catheter | In-hospital | TFG = 2 | 64.3% versus 12.5%* | Pos. | • EPI > No-EPI: • Efficacy ↑ |
| TFG = 3 | 28.6% versus 18.8%* | Pos. | ||||||
| HF | 28.5% versus 56.3% | Pos. | ||||||
| Death | 14.3% versus 43.7% | Pos. | ||||||
| MACE | 35.7% versus 81.2%* | Pos. | ||||||
| Follow-up 30 days |
EF [% mean change ] | +20.8% versus +6.8%*a | Pos. | |||||
| Darwish et al.8 | EPI versus ADN | Intracoronary, distal using aspiration catheter or pierced balloon inflated into a culprit lesion | In-hospital | TFG = 3 | 69.1% versus 52.7%* | Pos. | • EPI > ADN: • Efficacy ↑ |
|
| cTFC | 19.6% versus 21.5% | ~ | ||||||
| HF | 6.2% versus 10.7% | Pos. | ||||||
| Death | 1.2% versus 0% | Neg. | ||||||
| MACE | 7.4% versus 10.7% | Pos. | ||||||
| Follow-up 1 year |
HF | 6.3% versus 19.2%* | Pos. | |||||
| Death | 1.2% versus 2.7%* | Pos. | ||||||
| MACE | 11.3% versus 26.7%* | Pos. | ||||||
| Skelding et al.10 | EPI | Intracoronary, NR | In-hospital | TFG = 3 | 75.0%* | Pos. | • Efficacy (TIMI 3)in 3/4 of patients • No case of malignant arrhythmia in EPI group |
|
| Death | 3.4% | |||||||
| cTFC | 19.0* | Pos. | ||||||
| MBG 3 | 75.0%* | Pos. | ||||||
| EF [mean (SD)] | From 39.3 (6.49) to 42.1 (5.5)* | Pos. | ||||||
| Death | 8% | - | ||||||
| Follow-up 4 years |
Death | 0% | - | |||||
| MACE | 25.0% | - | ||||||
| Refractory no-reflow | Aksu et al.7 | EPI | Intracoronary, through the central lumen of an over-the-wire balloon catheter | In-hospital | TFG = 3 | 75.0%* | Pos. | • Efficacy (TIMI 3 and MBG 3) in 3/4 of patients • No case of sustained ventricular tachyarrhythmia |
| cTFC | 19.0* | Pos. | ||||||
| MBG 3 | 75.0%* | Pos. | ||||||
| EF [mean % of change (SD)] | 39.3 (6.49) to 42.1 (5.5)* | Pos. | ||||||
| Death | 8% | |||||||
| Follow-up 4 years |
Death | 0% | ||||||
| MACE | 25.0% | |||||||
ADN, adenosine; cTFC, corrected TIMI frame count; EF, ejection fraction; EPI, epinephrine; GPI, glycoprotein IIb/IIIa inhibitor; HF, heart failure; MACE, major adverse cardiac event; MBG, myocardial blush grade; NR, not reported; SD, standard deviation; TFG, TIMI flow grade; TIMI, thrombolysis in myocardial infarction; VF, ventricular fibrillation; VRP, verapamil.
a
EPI versus no-EPI [mean (SD)] 36.9 (13.9) to 44.6 (8.2) versus 38.3 (14.7) to 40.9 (34.5).
*
Statistically significant difference between groups.