Usefulness of Intracoronary Epinephrine in Severe Hypotension during Percutaneous Coronary Interventions

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 $181{\pm}24.8$ microgram), systolic and diastolic BP (from $53.8{\pm}13.0$ mm Hg up to $112.8{\pm}21.2$ mm Hg, from $35{\pm}7.6$ mm Hg up to $70.6{\pm}12.7$ mm Hg, respectively) and HR (from $39.4{\pm}5.1$ beats/min up to $96.8{\pm}29.3$ 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.