Coronary No-reflow Phenomenon: A Review of Therapeutic Pharmacological Agents

Document Type : Original Article


1 Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Cardiology Department, Razavi Hospital, Imam Reza International University, Mashhad, Iran.



Coronary no-reflow phenomenon (CNRP) is one of the leading catastrophic consequences of percutaneous coronary intervention (PCI). Although several preventive strategies have been advised, yet CNRP is not entirely controlled with pharmacological agents after diagnosis. This study is a review of therapeutic pharmacological agents used in various studies for post-PCI-CNRP. Several pharmacological agents have been introduced for reducing the burden of adverse outcome, before or during PCI. Although most of these agents have shown a remarkable effect on post-PCI CNRP incidence reduction, and it seems more powerful are still needed for a better validation of the results. It appears that intra lesion and distal intracoronary administrations would have a less systemic effect, and therefore may be safer than catheter injection. Moreover, adenosine, sodium nitroprusside, and calcium channel blockers are among the most routinely used methods. However, we believe that the best approach in treating or preventing no-reflow post-STMI might be combinational therapy. By the way, although there have been numerous studies on different agents capable of lessening the noreflow phenomenon, yet there is no exact guideline for choosing the most appropriate drug. A systematic review and meta-analysis on all available or practiced combinational pharmacotherapies to prevent PCI-related no-reflow are needed to suggest the most appropriate therapy.