Abstract: Objective To evaluate the effect of intravenous epinephrine on coronary no-reflow during percutaneous coronary intervention (PCI). Methods A total of 62 patients with coronary no-reflow and unstable hemodynamics in the Affiliated Hospital of Xuzhou Medical University from January 2014 to December 2017 were selected and their clinical data were retrospectively analyzed. According to their intravenous administration, the patients were divided into two groups: an intravenous epinephrine group (n=30) and an intracoronary sodium nitroprusside group (n=32). Their thrombolysis in myocardial infarction (TIMI) flow grades were evaluated, while the corrected TIMI frame count (CTFC) was calculated. Both groups were compared for postoperative conditions, including heart failure, arrhythmias, the incidences of major adverse cardiovascular events (MACEs) during hospitalization, the time to restore the flow,and left ventricular ejection fraction (LVEF) in one week follow-up. Results There was no statistical difference in the coronary angiography results and corresponding approaches after no-flow between the two groups (P>0.05). The percentage of patients achieving TIMI Ⅲ flow was 80.0% for the epinephrine group and 68.8% for the sodium nitroprusside group (P=0.312), but CTFC was 26.33±5.55 and 30.22±7.02, respectively (P=0.019). The time to restore the flow was shorter in the epinephrine group than that in the sodium nitroprusside group (P<0.01). No statistical difference was found in arrhythmias, acute heart failure, MACEs during hospitalization stay and LVEF in one week follow-up between the two groups (P>0.05). Conclusions Intravenous epinephrine can rapidly improve the coronary flow without increasing the incidence of MACEs during hospitalization stay.