Primary objective of the study is to evaluate the impact of adenosine pre-medication on incidence of slow flow/no-reflow after primary percutaneous coronary intervention.
All patients with acute STEMI undergoing primary PCI
Patients of either sex, ≥18 years of age.
STEMI patients with cardiogenic shock at presentation
Patients with heart block
Allergy to adenosine
Patients refuse to give consent for participation
Parallel
Adenosine pre-medication
DrugPatients will receive intracoronary adenosine before primary PCI in addition to standard pharmacological therapy: Dose: 2 mg for left coronary artery, 1 mg for right coronary artery Dilution: 20 mL normal saline Route: Intracoronary (proximal via guide catheter or distal via delivery device) Timing: Administered immediately prior to PCI Purpose: To evaluate whether adenosine pre-medication reduces the incidence of slow flow/no-reflow and improves myocardial perfusion outcomes (TIMI flow grade and Myocardial Blush Grade).
Standard care
Other interventionPatients will receive standard pharmacological management during primary PCI without adenosine pre-medication. Purpose: Serves as the control to assess the effect of adenosine on slow flow/no-reflow and myocardial perfusion.
Primary Outcome
Slow flow/no-reflow: will be categorized as final TIMI 0 to II flow
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