Effect of Intracoronary Adenosine on No-Reflow in Patients with Acute ST-Elevation Myocardial Infarction Undergoing Primary PCI: A Randomized Controlled Trial

No-reflow complicates 7% to 25% of primary percutaneous coronary interventions (PCI) for ST-elevation myocardial infarction (STEMI) and is associated with adverse outcomes. This trial evaluated whether intracoronary adenosine prevents no-reflow and improves left ventricular (LV) function. This single-center randomized controlled trial enrolled 200 STEMI patients undergoing primary PCI. Patients received either intracoronary adenosine (1 to 2 mg, n = 100) or standard care (n = 100) after achieving Thrombolysis in Myocardial Infarction (TIMI) 1 flow. Primary endpoints were postprocedural TIMI flow grade and myocardial blush grade. Secondary endpoints included LV ejection fraction and dimensions. Adenosine significantly reduced the incidence (33% vs 60%, p < 0.001) and improved TIMI III flow (86% vs 49%, p < 0.001) and myocardial blush grade III (68% vs 42%, p = 0.003). Post-PCI LV ejection fraction was higher in the adenosine group (42.64 ± 8.92% vs 38.40 ± 9.34%, p = 0.001) with smaller LV volumes. Intracoronary adenosine administered after establishing TIMI 1 flow significantly reduces no-reflow, improves myocardial perfusion, and preserves ventricular function in STEMI patients undergoing primary PCI. In conclusion, intracoronary adenosine administered during primary PCI was associated with reduced angiographic no-reflow, improved reperfusion markers, and more favorable early echocardiographic parameters among patients with STEMI. Given the single-center design and absence of long-term clinical outcomes, these findings should be considered preliminary and require external validation.