Korean Circ J.  2013 Nov;43(11):739-743. 10.4070/kcj.2013.43.11.739.

Usefulness of Intracoronary Epinephrine in Severe Hypotension during Percutaneous Coronary Interventions

• Choi JH
• Chun KJ
• Lee SH
• Chon MK
• Lee SG
• Kim JS
• Kim J
• Park YH
• Kim JH

• KMID: 2224805
• DOI: http://doi.org/10.4070/kcj.2013.43.11.739

Abstract

BACKGROUND AND OBJECTIVES
Life-threatening hypotension during percutaneous coronary interventions (PCI) is devastating for the patient and is associated with fatal adverse outcomes. The aim of our study was to assess the usefulness of intracoronary epinephrine in severe hypotension unresponsive to other measures during PCI.
SUBJECTS AND METHODS
We analyzed the Pusan National University Yangsan hospital cardiac catheterization laboratory database to identify patients who underwent PCI from December 2008 to July 2012. The outcomes were changes of blood pressure (BP) and heart rate (HR) before and after intracoronary epinephrine and in-hospital mortality.
RESULTS
A total of 30 patients who were initially stable and received intracoronary epinephrine for severe hypotension during PCI were included. Following administration of intracoronary epinephrine (dose 181+/-24.8 microgram), systolic and diastolic BP (from 53.8+/-13.0 mm Hg up to 112.8+/-21.2 mm Hg, from 35+/-7.6 mm Hg up to 70.6+/-12.7 mm Hg, respectively) and HR (from 39.4+/-5.1 beats/min up to 96.8+/-29.3 beats/min) were increased. Additionally, 21 patients (70%) showed hemodynamically acceptable responses to intracoronary epinephrine without the intraaortic balloon pump and temporary pacemaker during the PCI. In-hospital mortality was 17% (n=5).
CONCLUSION
Although our study was small, intracoronary epinephrine was found to be well tolerated and resulted in prompt and successful recovery from severe hypotension in most patients when other measures were ineffective. Intracoronary epinephrine could be a safe and useful measure in patients developing severe hypotension during PCI.

Keyword

Coronary vessels; Epinephrine; Hypotension; Percutaneous coronary intervention

MeSH Terms

Blood Pressure
Cardiac Catheterization
Cardiac Catheters
Coronary Vessels
Epinephrine*
Heart Rate
Hospital Mortality
Humans
Hypotension*
Percutaneous Coronary Intervention*
Epinephrine

Figure

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  Fig. 1 The regimen of intracoronary epinephrine. The regimen of intracoronary epinephrine was two ampoules of 1 : 1000 epinephrine (1 µg/mL) mixed into 100 mL of normal saline (20 µg/mL).

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