Efficacy of intracoronary nicardipine in the treatment of no‐reflow during percutaneous coronary intervention

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Abstract
Objectives: The goal of this study was to evaluate the safety and efficacy of nicardipine in reversing no-reflow during percutaneous coronary intervention (PCI). Background: No-reflow is a common complication of PCI in patients with acute coronary syndromes or venous bypass graft disease. Although nicardipine has an attractive pharmacological profile and has been used clinically to treat no-reflow, there is a paucity of published data regarding its effectiveness in this setting. Methods: We conducted a retrospective analysis of 72 consecutive patients who received intracoronary nicardipine to reverse no-reflow during coronary intervention. Qualitative TIMI flow grade and quantitative TIMI frame count methods were used to assess the efficacy of nicardipine. Results: A mean of 460 ± 360 mcg of intracoronary nicardipine was used. No-reflow was successfully reversed with complete restoration of TIMI 3 flow in 71 of 72 patients (98.6%). TIMI flow grade improved from 1.65 ± 0.53 prior to nicardipine to 2.97 ± 0.24 after treatment (P < 0.001). TIMI frame count decreased from 57 ± 40 at the time of no-reflow to 15 ± 12 after nicardipine administration (P < 0.001). Nicardipine therapy was well tolerated without adverse hemodynamic or chronotropic effects.Conclusions: In this largest series to date, intracoronary nicardipine was demonstrated to be a safe and highly effective pharmacological agent to reverse no-reflow during PCI.