title: Verapamil reverses myocardial no-reflow after primary percutaneous coronary intervention in patients with acute myocardial infarction.
abstract: The present study evaluated the efficacy of intracoronary administration of verapamil to attenuate the no-reflow phenomenon following the primary percutaneous coronary intervention (PCI) in patients with the ST-segment elevation acute myocardial infarction (STEMI). A total of 201 patients with STEMI who underwent primary PCI within 12 h from the beginning of the heart attack were included. The no-reflow phenomenon was defined as substantial coronary anterograde flow of TIMI ≤2. Verapamil (100-200 μg) was injected into coronary artery immediately after no-reflow; the coronary arteriography was repeated later. Hundred and ninety-eight patients with STEMI successfully underwent primary PCI, and 246 stents were implanted with the average of 1.2 stents per patient. No-reflow occurred in 25 out of 198 patients (12.6%). Twenty-one (84%) patients developed the flow of TIMI ≥3 after intracoronary administration of verapamil, as revealed by repeated coronary angiography. Two patients developed transient hypotension which normalized without treatment within 3-5 min. Three patients showed sinus bradycardia, in one patient there was transient II sinoatrial block, and one patient developed type 1 atrioventricular block. All adverse effects were alleviated after intravenous injection of atropine (0.5-1 mg). In conclusion, the no-reflow phenomenon following primary PCI in patients with STEMI is significantly improved by intracoronary administration of verapamil which is useful to reduce cardiovascular events during operation.
authors.affiliation: Department of Cardiology, Xuzhou Cardiovascular Diseases Institute, Xuzhou Hospital Affiliated East South University School of Medicine, No. 199 Jiefang Road, Xuzhou, 221009, China, fuqiang@medmail.com.cn.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Fu
authors.forename: Wen
authors.initials: W
authors.lastname: Lu
authors.forename: Yi-jie
authors.initials: YJ
authors.lastname: Huang
authors.forename: Qiang
authors.initials: Q
authors.lastname: Wu
authors.forename: Lin-guang
authors.initials: LG
authors.lastname: Wang
authors.forename: Hai-bo
authors.initials: HB
authors.lastname: Wang
authors.forename: Shu-zhong
authors.initials: SZ
authors.lastname: Jiang
authors.forename: Yan-jiong
authors.initials: YJ
authors.lastname: Wang
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001285:Atropine / Q000627:therapeutic use; D001919:Bradycardia / Q000209:etiology; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D007022:Hypotension / Q000209:etiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery*; D054318:No-Reflow Phenomenon / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects; D014700:Verapamil / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D014665:Vasodilator Agents; D001285:Atropine; D014700:Verapamil