Key result
Intracoronary verapamil significantly increased the percentage of patients achieving TIMI III flow post-treatment compared to adenosine (92% vs. 78%, p=0.03) in normotensive patients with acute coronary syndrome.
Why the study?
The study aimed to compare the efficacy of intracoronary verapamil versus adenosine for managing the no-reflow phenomenon in normotensive ACS patients undergoing PCI.
Does intracoronary verapamil improve myocardial perfusion compared to adenosine in normotensive patients with acute coronary syndrome experiencing no-reflow during PCI?
Observational (n=150)
Blinded data collection and analysis
No
Does intracoronary verapamil improve myocardial perfusion compared to adenosine in normotensive patients with acute coronary syndrome experiencing no-reflow during PCI?
Absolute Event Rate: 92% vs 78%
p-value: p=0.03
Intracoronary verapamil provides a modest but statistically significant advantage over adenosine in improving immediate angiographic myocardial perfusion (TIMI flow) in normotensive ACS patients experiencing no-reflow during PCI.
Observational data suggest verapamil may yield higher TIMI III flow than adenosine in no-reflow; leaves open optimal agent selection pending randomized trials.
Objectives: This study aimed to compare the efficacy of intracoronary verapamil versus adenosine in managing the no-reflow phenomenon in normotensive patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). Methodology: We conducted a prospective observational study at Hayatabad Medical Complex Peshawar from March 2023 to March 2024. A total of 150 normotensive ACS patients scheduled for PCI were enrolled and treated with either intracoronary verapamil (200 µg) or adenosine (48 µg) based on the clinical judgment of the treating cardiologist upon identifying the no-reflow phenomenon. The primary outcomes included improvements in myocardial perfusion, assessed by the achievement of TIMI III flow immediately and at 30 minutes via angiographic analysis. Secondary outcomes assessed were microvascular resistance (IMR), endothelial function (FMD), and the incidence of major adverse cardiac events (MACE) within six months. Results: The verapamil group exhibited a higher percentage of patients achieving TIMI III flow post-treatment compared to the adenosine group (92% vs. 78%, p = 0.03). Both treatment groups demonstrated reductions in IMR (verapamil: 18.5 ± 2.8 units; adenosine: 19.1 ± 3.1 units, p = 0.29) and improvements in FMD (verapamil: 4.1 ± 0.5%; adenosine: 3.9 ± 0.6%, p = 0.15). The incidence of MACE was 18% in the verapamil group and 8% in the adenosine group, indicating comparable safety profiles for both agents. Conclusion: Intracoronary verapamil and adenosine both effectively enhance myocardial perfusion and endothelial function in normotensive ACS patients following PCI. Verapamil showed a slight advantage in achieving TIMI III flow and reducing microvascular resistance, suggesting it may offer superior benefits in specific clinical scenarios. These results support the use of both agents in managing the no-reflow phenomenon, with potential preference for verapamil in particular contexts.
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Amin et al. (2024) conducted an observational in Acute Coronary Syndrome with no-reflow phenomenon (n=150). Intracoronary verapamil vs. Intracoronary adenosine (48 µg) was evaluated on Achievement of TIMI III flow post-treatment (p=0.03). Intracoronary verapamil significantly increased the percentage of patients achieving TIMI III flow post-treatment compared to adenosine (92% vs. 78%, p=0.03) in normotensive patients with acute coronary syndrome.
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