title: Nitroglycerin plus diltiazem versus nitroglycerin alone for spasm prophylaxis with transradial approach.
abstract: OBJECTIVE
  The aim of this study was to compare the efficacy of nitroglycerin and diltiazem versus nitroglycerin alone in preventing radial artery spasm (RAS) during transradial coronary procedures.
  
  
  BACKGROUND
  Spasm after transradial access decreases procedural success. Multiple spasmolytics are used to prevent spasm. Individual efficacy of these agents is not conclusively established.
  
  
  METHODS
  One hundred and fifty patients undergoing coronary procedures through radial artery were enrolled and divided into two groups of 75 patients each. Patients in Group A received 200 μg nitroglycerin plus 2.5 mg diltiazem intra-arterially, and group B patients received 200 μg nitroglycerin plus placebo (saline). Blood pressure (BP) and heart rate (HR) were recorded at baseline and for 5 minutes after cocktail was given. Clinical signs of RAS, such as pain and resistance during catheter maneuver, were recorded in both groups during the procedure.
  
  
  RESULTS
  Systolic and diastolic BP decreased significantly in Group A compared to Group B after cocktail was given (P<.001 and P<.022, respectively). There were no significant changes of HR in either group. There was no significant difference in the incidence of clinical RAS between Group A (diltiazem plus nitroglycerin) versus Group B (nitroglycerin alone) (5% vs 7%; P=1.000). Furthermore, we found higher incidence of local burning pain in the forearm in patients that receive intra-arterial diltiazem plus nitroglycerin compared to nitroglycerin alone (21% vs 9%; P=.041).
  
  
  CONCLUSIONS
  Diltiazem plus nitroglycerin showed no advantage compared to nitroglycerin alone in prevention of RAS in transradial approach.
authors.affiliation: Department of Cardiovascular Sciences, Smt. N.H.L. Municipal Medical College, Sheth K.M. School of Post Graduate Medicine and Research, Sheth V.S. General Hospital and SAL Hospital and Medical Institute, TCVS Pvt. Ltd., Ahmedabad, Gujarat, India. drsuryadharma@yahoo.com
authors.forename: Surya
authors.initials: S
authors.lastname: Dharma
authors.forename: Sanjay
authors.initials: S
authors.lastname: Shah
authors.forename: Rajnikant
authors.initials: R
authors.lastname: Radadiya
authors.forename: Chirayu
authors.initials: C
authors.lastname: Vyas
authors.forename: Samir
authors.initials: S
authors.lastname: Pancholy
authors.forename: Tejas
authors.initials: T
authors.lastname: Patel
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D002318:Cardiovascular Diseases / Q000628:therapy; D004110:Diltiazem / Q000494:pharmacology / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000494:pharmacology / Q000627:therapeutic use*; D011446:Prospective Studies; D017534:Radial Artery / Q000187:drug effects / Q000503:physiopathology*; D013035:Spasm / Q000517:prevention & control*; D014652:Vascular Diseases / Q000517:prevention & control*; D014661:Vasoconstriction / Q000187:drug effects / Q000502:physiology; D014665:Vasodilator Agents / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D014665:Vasodilator Agents; D004110:Diltiazem; D005996:Nitroglycerin