title: How to limit radial artery spasm during percutaneous coronary interventions: The spasmolytic agents to avoid spasm during transradial percutaneous coronary interventions (SPASM3) study.
abstract: OBJECTIVE
  To compare the efficacy of three vasodilators in preventing radial artery spasm (RAS) in patients undergoing transradial percutaneous coronary interventions (PCI).
  
  
  RESULTS
  731 patients were randomized to receive diltiazem 5 mg, verapamil 2.5 mg, or isosorbide dinitrate (ISDN) 1 mg before coronary intervention. RAS occurred in 20.1% in the whole population and was significantly reduced by verapamil and ISDN compared to diltiazem (16.2, 17.2, and 26.6%, respectively; P < 0.006). There was also a trend towards less severe pain (more than 8 on a numerical scale from 0 [no pain] to 10 [maximal pain]), and less severe RAS (complete catheter blockage or severe pain), among patients treated by verapamil compared to ISDN and diltiazem (1.3% vs. 2.8% vs. 2.9%, P = 0.43 and 5.1% vs. 6.2% vs. 9.5%, respectively, P = 0.13). No difference was found between the three vasodilators in terms of crossover or safety events. Female gender, failure at first attempt to access the radial artery, emergency procedures, and the use of diltiazem were independent predictors of RAS.
  
  
  CONCLUSIONS
  Verapamil and ISDN considerably reduce the incidence of RAS compared to diltiazem during transradial PCI.
authors: AP-HP, Hôpital Cochin, Service de Cardiologie, Paris, France; Université Paris Descartes. Faculté de Médecine Paris Descartes, Paris, France.
authors: Julien
authors: J
authors: Rosencher
authors: Aurès
authors: A
authors: Chaïb
authors: Franck
authors: F
authors: Barbou
authors: Marc-Antoine
authors: MA
authors: Arnould
authors: Arthur
authors: A
authors: Huber
authors: Emmanuel
authors: E
authors: Salengro
authors: Arnaud
authors: A
authors: Jégou
authors: Philippe
authors: P
authors: Allouch
authors: Stéphane
authors: S
authors: Zuily
authors: Fadila
authors: F
authors: Mihoub
authors: Olivier
authors: O
authors: Varenne
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D006328:Cardiac Catheterization / Q000379:methods; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000628:therapy; D004110:Diltiazem / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007548:Isosorbide Dinitrate / Q000008:administration & dosage*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D017534:Radial Artery / Q000187:drug effects*; D013035:Spasm / Q000517:prevention & control*; D016896:Treatment Outcome; D014661:Vasoconstriction / Q000187:drug effects; D014665:Vasodilator Agents / Q000008:administration & dosage; D014700:Verapamil / Q000008:administration & dosage*
chemical_list: D014665:Vasodilator Agents; D014700:Verapamil; D004110:Diltiazem; D007548:Isosorbide Dinitrate
keywords: percutaneous coronary intervention; radial artery spasm; transradial approach; vasodilators