The effect of verapamil on the restoration of myocardial perfusion and functional recovery in patients with angiographic no-reflow after primary percutaneous coronary intervention.
OBJECTIVE
Angiographic thrombolysis in myocardial infarction (TIMI) flow grade < or = 2 after primary percutaneous coronary intervention (PCI), defined as angiographic no-reflow, predicts poor functional recovery in patients with acute myocardial infarction. We investigated the effect of verapamil on the restoration of myocardial perfusion and functional recovery in patients with angiographic no-reflow after PCI.


METHODS
99mTc tetrofosmin single photon emission computed tomographic (SPECT) imaging was performed (before, immediately after and 1 month after PCI) in 101 consecutive patients with acute myocardial infarction. The defect score was calculated as the sum of perfusion defect in a 13-segment model (scores of 3, complete defect to 0, normal perfusion). The asynergic score, defined as the number of asynergic segments, was assessed by echocardiography before and 1 month later. Multiple logistic regression analysis was performed to elucidate the effect of verapamil administration.


RESULTS
Of 101 patients, 32 (31%) had angiographic no-reflow and were divided into two groups: 18 patients with verapamil (group 1) and 14 patients without verapamil (group 2). Sixty-nine patients had TIMI grade 3 reflow after PCI (group 3). The change in the defect score 1 month after PCI in group 1 was significantly larger than that in group 2 (P = 0.003). The asynergic score improved more at 1 month in group 1 compared to that in group 2 (P = 0.007). Moreover, logistic regression analysis revealed that TIMI grade reflow < or = 2 after PCI (P = 0.04, OR = 5.51), the defect score before PCI (P = 0.03, OR = 1.15), the asynergic score before PCI (P = 0.01, OR = 0.64) and the administration of verapamil (P = 0.002, OR = 22.4) were independently associated with successful myocardial reperfusion immediately after PCI.


CONCLUSIONS
Intracoronary verapamil restored myocardial perfusion in patients with angiographic no-reflow after PCI and lead to better functional recovery after acute myocardial infarction.
Division of Cardiology, Takarazuka Hospital, Hyogo, Japan.
Shigeo
S
Umemura
Seishi
S
Nakamura
Tetsuro
T
Sugiura
Yoshiaki
Y
Tsuka
Keisuke
K
Fujitaka
Susumu
S
Yoshida
Masato
M
Baden
Toshiji
T
Iwasaka
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D015428:Myocardial Reperfusion Injury / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000209:etiology; D011877:Radionuclide Imaging; D020127:Recovery of Function / Q000187:drug effects; D016896:Treatment Outcome; D014700:Verapamil / Q000627:therapeutic use*
D014700:Verapamil