Effects of verapamil and adenosine in an adjunct to tirofiban on resolution and prognosis of noreflow phenomenon in patients with acute myocardial infarction.
OBJECTIVE
We aimed to investigate the effects of verapamil and adenosine in an adjunct to intravenous tirofiban on management and prognosis of no-reflow phenomenon during primary percutaneous coronary intervention (PPCI) and to compare their efficacies on reversing of no-reflow phenomenon and short and midterm survival.


METHODS
We included 46 patients with acute ST-segment elevation myocardial infarction (STEMI) and occurrence of no-reflow phenomenon after PPCI. All patients received intravenous tirofiban and then randomized into one of the following 3 groups: intracoronary adenosine (N.=16), intracoronary verapamil (N.=15) or placebo (N.=15).


RESULTS
Intracoronary verapamil therapy had significant effect in restoring impaired coronary blood flow by decreasing thrombolysis in myocardial infarction (TIMI) frame count from 73±44 to 52±48 (P=0.024). However, adenosine and serum physiologic administration were not found to be so effective in decreasing TIMI frame count (from 81±35 to 71±46, P=0.084; from 74±32 to 71±37, P=0.612, respectively). In-hospital and 6-month survival rates were similar among groups.


CONCLUSIONS
In conclusion, intracoronary verapamil restored the impaired coronary blood flow more effectively than adenosine or placebo. However, none of them has changed the clinical course in the first 6 months.
Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey - ismailbiyikmd@yahoo.com.
I
I
Faruk Akturk
A
A
Arif Yalcin
I
I
Biyik
C
C
Sarikamis
N
N
Turhan Caglar
M
M
Erturk
O
O
Celik
F
F
Uzun
I
I
Murat Caglar
E
E
Oner
D000241:Adenosine / Q000008:administration & dosage / Q000627:therapeutic use*; D000368:Aged; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy*; D054318:No-Reflow Phenomenon / Q000188:drug therapy* / Q000209:etiology; D062645:Percutaneous Coronary Intervention / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate; D000077466:Tirofiban; D014443:Tyrosine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use; D014700:Verapamil / Q000008:administration & dosage / Q000627:therapeutic use*
D005343:Fibrinolytic Agents; D014665:Vasodilator Agents; D014443:Tyrosine; D014700:Verapamil; D000077466:Tirofiban; D000241:Adenosine