{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T07:45:16Z","timestamp":1790063116949,"version":"4.0.1"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2022,2,1]],"date-time":"2022-02-01T00:00:00Z","timestamp":1643673600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Interventions"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Intracoronary epinephrine has been effectively used in treating refractory no-reflow, but there is a dearth of data on its use as a first-line drug in normotensive patients in comparison to the widely used adenosine.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>In this open-labeled randomized clinical trial, 201 patients with no-reflow were randomized 1:1 into intracoronary epinephrine as the treatment group and intracoronary adenosine as the control group and followed for 1 month. The primary end points were improvement in coronary flow, as assessed by TIMI (Thrombolysis in Myocardial Infarction) flow, frame counts, and myocardial blush. Secondary end points were in-hospital and short-term mortality and major adverse cardiac events.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              In all, 101 patients received intracoronary epinephrine and 100 patients received adenosine. Epinephrine was generally well tolerated with no immediate table death or ventricular fibrillation. No-reflow was more effectively improved with epinephrine with final TIMI III flow (90.1% versus 78%,\n              <jats:italic>P<\/jats:italic>\n              =0.019) and final corrected TIMI frame count (24\u00b18.43 versus 26.63\u00b19.22,\n              <jats:italic>P<\/jats:italic>\n              =0.036). However, no significant difference was observed in final grade III myocardial blush (55.4% versus 45%,\n              <jats:italic>P<\/jats:italic>\n              =0.139), mean reduction of corrected TIMI frame count (\u221225.71\u00b111.79 versus \u221226.08\u00b111.71,\n              <jats:italic>P<\/jats:italic>\n              =0.825), in-hospital and short-term mortality, and major adverse cardiac events.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Epinephrine is relatively safe to use in no-reflow in normotensive patients. A significantly higher frequency of post-treatment TIMI III flow grade and lower final corrected TIMI frame count with relatively better achievement of myocardial blush grade III translate into it displaying relatively better efficacy than adenosine.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Registration:<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              ; Unique identifier: NCT04699110.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circinterventions.121.011408","type":"journal-article","created":{"date-parts":[[2022,1,10]],"date-time":"2022-01-10T10:00:31Z","timestamp":1641808831000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":32,"title":["Comparison of Intracoronary Epinephrine and Adenosine for No-Reflow in Normotensive Patients With Acute Coronary Syndrome (COAR Trial)"],"prefix":"10.1161","volume":"15","clinical-trial-number":[{"clinical-trial-number":"nct04699110","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2665-1410","authenticated-orcid":true,"given":"Kamran Ahmed","family":"Khan","sequence":"first","affiliation":[{"name":"Department of Adult Cardiology (K.A.K., N.Q., T.S., J.A.S., D.K., R.K., D.Q., U.Y., J.J.), National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadeem","family":"Qamar","sequence":"additional","affiliation":[{"name":"Department of Adult Cardiology (K.A.K., N.Q., T.S., J.A.S., D.K., R.K., D.Q., U.Y., J.J.), National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tahir","family":"Saghir","sequence":"additional","affiliation":[{"name":"Department of Adult Cardiology (K.A.K., N.Q., T.S., J.A.S., D.K., R.K., D.Q., U.Y., J.J.), National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jawaid Akbar","family":"Sial","sequence":"additional","affiliation":[{"name":"Department of Adult Cardiology (K.A.K., N.Q., T.S., J.A.S., D.K., R.K., D.Q., U.Y., J.J.), National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4774-6876","authenticated-orcid":true,"given":"Dileep","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Adult Cardiology (K.A.K., N.Q., T.S., J.A.S., D.K., R.K., D.Q., U.Y., J.J.), National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajesh","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Adult Cardiology (K.A.K., N.Q., T.S., J.A.S., D.K., R.K., D.Q., U.Y., J.J.), National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4440-4176","authenticated-orcid":true,"given":"Danish","family":"Qayyum","sequence":"additional","affiliation":[{"name":"Department of Adult Cardiology (K.A.K., N.Q., T.S., J.A.S., D.K., R.K., D.Q., U.Y., J.J.), National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umamah","family":"Yasin","sequence":"additional","affiliation":[{"name":"Department of Adult Cardiology (K.A.K., N.Q., T.S., J.A.S., D.K., R.K., D.Q., U.Y., J.J.), National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8763-1934","authenticated-orcid":true,"given":"Javed","family":"Jalbani","sequence":"additional","affiliation":[{"name":"Department of Adult Cardiology (K.A.K., N.Q., T.S., J.A.S., D.K., R.K., D.Q., U.Y., J.J.), National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7941-8191","authenticated-orcid":true,"given":"Musa","family":"Karim","sequence":"additional","affiliation":[{"name":"Department of Clinical Research (M.K.), National Institute of Cardiovascular Diseases (NICVD), Karachi, 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