Dipyridamole versus verapamil for treatment of no-reflow during primary angioplasty.
BACKGROUND
No previous study has assessed the possible role of dipyridamole for treatment of no-reflow during acute myocardial infarction (AMI).


RESULTS
Forty-six consecutive patients (age 64 ± 13 years, 37 men) with no reflow during primary percutaneous coronary intervention were randomized to initial treatment with either dipyridamole (0.56 mg/kg i.c.) or verapamil (1 mg i.c.). Patients with unsuccessful response to the first drug were then switched to the second one (from dipyridamole to verapamil and vice versa). Angiographic end-points were similar in the two groups: TIMI flow was 2.9 ± 0.3 versus 2.8 ± 0.4 (P = 0.28), corrected TIMI frame count (cTFC) 26.4 ± 8.8 versus 31.6 ± 11.4 (P = 0.14) and TIMI myocardial perfusion grade (TMPG) 2.1 ± 1.2 versus 1.7 ± 1.2 (P = 0.12) in dipydidamole and verapamil group, respectively. Optimal myocardial perfusion (TMPG-3) was achieved by 56% of patients with dipyridamole and 39% with verapamil (P = 0.38). In patients with persistent no-reflow administration of dipyridamole on top of verapamil resulted in a significant further improvement of cTFC (from 31.6 ± 11.4 to 24.6 ± 5.7 P = 0.009) and of TMPG (from 1.7 ± 1.2 to 2.6 ± 0.7, P = 0.007). Conversely, verapamil did not induce a significant improvement in coronary flow (cTFC changed from 26.4 ± 8.8 to 24.5 ± 8.5, P = 0.28 and TMPG from 2.1 ± 1.2 to 2.4 ± 1.2, P = 0.13). There were no significant side effects induced by dipyridamole, while verapamil caused AV block in 9% of cases.


CONCLUSIONS
Dipyridamole is a safe and effective first-line drug for treatment of no-reflow. Dipyridamole can also be successfully used in patients with incomplete response to verapamil.
Tanzilli
Gaetano
G
Dipartimento Cuore e Grossi Vasi A. Reale, Policlinico Umberto I, Universita' La Sapienza, Roma, Italy.
Greco
Cesare
C
Pasceri
Vincenzo
V
Pelliccia
Francesco
F
Arrivi
Alessio
A
Placanica
Attilio
A
Mangieri
Enrico
E
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000187:drug effects*; D004176:Dipyridamole / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D057915:Drug Substitution; D005260:Female; D006801:Humans; D007263:Infusions, Parenteral; D007558:Italy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D055414:Myocardial Perfusion Imaging; D054318:No-Reflow Phenomenon / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D011446:Prospective Studies; D016037:Single-Blind Method; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D014700:Verapamil / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
D014665:Vasodilator Agents; D004176:Dipyridamole; D014700:Verapamil