Pretreatment with intragraft verapamil prior to percutaneous coronary intervention of saphenous vein graft lesions: results of the randomized, controlled vasodilator prevention on no-reflow (VAPOR) trial.
BACKGROUND
Intragraft verapamil is effective in treating no-reflow during saphenous vein graft (SVG) percutaneous coronary intervention (PCI). In this study, we assessed the use of intragraft verapamil given pre-PCI to prevent no-reflow.


METHODS
Patients undergoing SVG PCI were randomized to receive intragraft 200  g verapamil or no verapamil immediately prior to PCI. Pre- and post-PCI, vessel flow was assessed using TIMI flow grade and TIMI frame count by blinded angiographic readers. Tissue level perfusion in the graft territory was assessed using the TIMI myocardial perfusion grade (TMPG). CK-MB or troponin I levels were measured 6 12 hours post-PCI.


RESULTS
Ten patients were randomized to the verapamil group and 12 were assigned to the placebo group. No-reflow occurred in 33.3% of the placebo group, compared to none of the verapamil patients (p = 0.10). The use of intragraft verapamil prior to SVG PCI increased flow rate in the vessel as assessed by TIMI frame count (53.3   22.4% faster in the verapamil group versus 11.5   38.9% in the placebo group; p = 0.016). There was a trend toward improved myocardial perfusion as assessed by TMPG. There was no difference in the incidence of cardiac biomarker release following PCI.


CONCLUSIONS
Intragraft administration of verapamil prior to saphenous vein graft PCI reduces no-reflow and is associated with a trend toward improved myocardial perfusion.
Michaels
Andrew D
AD
University of California at San Francisco Medical Center, Division of Cardiology, 505 Parnassus Avenue, Box 0124, San Francisco, CA 94143-0124, USA. andrewm@itsa.ucsf.edu
Appleby
Mark
M
Otten
Matthew H
MH
Dauterman
Kent
K
Ports
Thomas A
TA
Chou
Tony M
TM
Gibson
C Michael
CM
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015425:Myocardial Reperfusion / Q000379:methods*; D011300:Preoperative Care; D012039:Regional Blood Flow; D012501:Saphenous Vein / Q000637:transplantation; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage*; D014700:Verapamil / Q000008:administration & dosage*
D014665:Vasodilator Agents; D014700:Verapamil