title: REstoration of COronary flow in patients with no-reflow after primary coronary interVEntion of acute myocaRdial infarction (RECOVER).
abstract: BACKGROUND
  No randomized trial has been conducted to compare different vasodilators for treating no-reflow during primary percutaneous coronary intervention (PCI) for ST-segment elevation acute myocardial infarction.
  
  
  METHODS
  The prospective, randomized, 2-center trial was designed to compare the effect of 3 different vasodilators on coronary no-reflow. A total of 102 patients with no-reflow in primary PCI were randomized to receive intracoronary infusion of diltiazem, verapamil, or nitroglycerin (n = 34 in each group) through selective microcatheter. The primary end point was coronary flow improvement in corrected thrombolysis in myocardial infarction frame count (CTFC) after administration of the drug.
  
  
  RESULTS
  Compared with that of the nitroglycerin group, there was a significant improvement of CTFC after drug infusion in the diltiazem and verapamil groups (42.4 frames vs 28.1 and 28.4 frames, P < .001). The improvement in CTFC was similar between the diltiazem and verapamil groups (P = .9). Compared with the nitroglycerin group, the diltiazem and verapamil groups had more complete ST-segment resolution at 3 hours after PCI, lower peak troponin T level, and lower N-terminal pro-B-type natriuretic peptide levels at 1 and 30 days after PCI. After drug infusion, the drop of heart rate and systolic blood pressure in the verapamil group was greater than that in the diltiazem and nitroglycerin groups.
  
  
  CONCLUSIONS
  Intracoronary infusion of diltiazem or verapamil can reverse no-reflow more effectively than nitroglycerin during primary PCI for acute myocardial infarction. The efficacy of diltiazem and verapamil is similar, and diltiazem seems safer.
authors.affiliation: Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, China.
authors.forename: Dong
authors.initials: D
authors.lastname: Huang
authors.forename: Juying
authors.initials: J
authors.lastname: Qian
authors.forename: Lei
authors.initials: L
authors.lastname: Ge
authors.forename: Xuejuan
authors.initials: X
authors.lastname: Jin
authors.forename: Huigen
authors.initials: H
authors.lastname: Jin
authors.forename: Jianying
authors.initials: J
authors.lastname: Ma
authors.forename: Zongjun
authors.initials: Z
authors.lastname: Liu
authors.forename: Feng
authors.initials: F
authors.lastname: Zhang
authors.forename: Lili
authors.initials: L
authors.lastname: Dong
authors.forename: Xiangfei
authors.initials: X
authors.lastname: Wang
authors.forename: Kang
authors.initials: K
authors.lastname: Yao
authors.forename: Junbo
authors.initials: J
authors.lastname: Ge
mesh_terms: D000368:Aged; D003326:Coronary Circulation / Q000187:drug effects / Q000502:physiology*; D004110:Diltiazem / Q000008:administration & dosage / Q000009:adverse effects; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000503:physiopathology*; D020097:Natriuretic Peptide, Brain / Q000097:blood / Q000187:drug effects; D005996:Nitroglycerin / Q000008:administration & dosage / Q000009:adverse effects; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood / Q000187:drug effects; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects; D014700:Verapamil / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D020107:Troponin T; D014665:Vasodilator Agents; D020097:Natriuretic Peptide, Brain; D014700:Verapamil; D004110:Diltiazem; D005996:Nitroglycerin