Attenuation of the no-reflow phenomenon after coronary angioplasty for acute myocardial infarction with intracoronary papaverine

Am Heart J. 1996 Nov;132(5):959-63. doi: 10.1016/s0002-8703(96)90005-8.


The no-reflow phenomenon is observed as reduction of coronary blood flow on the angiograms (angiographic no-reflow) after immediate percutaneous transluminal coronary angioplasty (PTCA) in patients with acute myocardial infarction (AMI). To assess whether a potent coronary microvascular dilator--papaverine--could attenuate the no-reflow phenomenon, nine patients with AMI who were found to have angiographic no-reflow after PTCA were studied. Angiographic no-reflow was defined as the Thrombolysis in Myocardial Infarction flow grade 1 or 2 without any mechanical obstructions in the epicardial artery. A bolus dose of 10 mg of intracoronary papaverine was administered, and the flow grade was again evaluated. Intracoronary papaverine caused a significant improvement of the flow grade (p= 0.0152). The number of cineframes that were required for the contrast medium to pass two selected landmarks on the angiograms also significantly decreased (41 +/- 17 frames to 18 +/- 8 frames, p= 0.0039). Thus intracoronary papaverine attenuated angiographic no-reflow that occurred after PTCA for AMI.

MeSH terms

  • Adult
  • Aged
  • Angioplasty, Balloon, Coronary*
  • Coronary Angiography
  • Coronary Circulation / drug effects*
  • Female
  • Heart / physiology
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / diagnostic imaging
  • Myocardial Infarction / physiopathology*
  • Myocardial Infarction / therapy*
  • Papaverine / pharmacology*
  • Regional Blood Flow
  • Vasodilator Agents / pharmacology*


  • Vasodilator Agents
  • Papaverine