Key result
Intracoronary verapamil improves post-PCI TIMI flow compared with adenosine in acute coronary syndrome.
Why the study?
There is little evidence directly comparing intracoronary adenosine and verapamil in normotensive ACS patients undergoing PCI to manage no-reflow, leaving uncertainty about the more effective agent.
Does intracoronary adenosine compare favorably to intracoronary verapamil in improving post-procedural TIMI flow grade in normotensive patients with acute coronary syndrome undergoing PCI?
Observational (n=120)
Randomly allocated
No
Does intracoronary adenosine compare favorably to intracoronary verapamil in improving post-procedural TIMI flow grade in normotensive patients with acute coronary syndrome undergoing PCI?
Absolute Event Rate: 2.9% vs 2.6%
p-value: p=0.02
Intracoronary verapamil produces superior immediate angiographic flow restoration compared to adenosine in normotensive ACS patients, though neither agent dominates across microvascular and long-term clinical outcomes.
May favor verapamil for immediate post-PCI flow in normotensive ACS; leaves open microvascular and clinical outcome effects in this observational cohort.
Objective:To compare the efficacy of intracoronary adenosine and verapamil in improving myocardial perfusion in normotensive patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).Study Design:This was a prospective observational study.Place and Duration:This study was conducted at Chandka Medical College Hospital Larkana, while the cath procedures were performed at (SICVD) Larkanafrom February 2025to February 2026.Methods:A total of 120 normotensive patients with ACS undergoing PCI were enrolled and equally allocated into 2 groups. The adenosine group (n=60) received intracoronary adenosine, while the verapamil group (n=60) received intracoronary verapamil. Post-procedural Thrombolysis in Myocardial Infarction (TIMI) flow gradewas the primary outcome variable. Secondary outcomes includeda 6-month major adverse cardiac events (MACE), Index of Microcirculatory Resistance (IMR), and flow-mediated dilatation (FMD). Independent-samples t-test and chi-square test were used for analysis, with p<0.05 considered significant.Results:Baseline variables were comparable between groups. Mean age was 60.0 ± 7.0 years in the adenosine group and 58.0 ± 6.0 years in the verapamil group (p=0.34). Male participants accounted for 48.3% and 53.3%, respectively (p=0.57). Post-treatment TIMI flow was significantly higher in the verapamil group than in the adenosine group (2.9 ± 0.4 vs 2.6 ± 0.5, p=0.02). Post-procedural IMR was lower in the adenosine group (18.0 ± 2.0 vs 20.0 ± 3.0, p=0.08), while post-procedural FMDwas higher in the verapamil group (4.3 ± 0.6 vs 4.0 ± 0.7, p=0.12). At 6 months, MACE was lower in the adenosine group (11.7% vs 23.3%, p>0.05).Conclusion:Intracoronary verapamil showed superior immediate improvement in TIMI flow, while adenosine demonstrated a favorable trend in IMR and lower 6-month MACE. However, neither drug was consistently superior across all outcomes.
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Hussain et al. (2026) conducted an observational in Acute Coronary Syndrome (ACS) with No-Reflow (n=120). Intracoronary verapamil vs. Intracoronary adenosine was evaluated on Post-procedural Thrombolysis in Myocardial Infarction (TIMI) flow grade (p=0.02). Intracoronary verapamil significantly improved immediate post-procedural TIMI flow grade compared to intracoronary adenosine (2.9 vs 2.6, p=0.02) in normotensive patients with acute coronary syndrome undergoing PCI.
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