title: Efficacy and safety of intracoronary verapamil versus sodium nitroprusside for the prevention of microvascular obstruction during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction.
abstract: OBJECTIVE
  The aim of this study was to compare the role of intracoronary (IC) verapamil versus sodium nitroprusside (SNP) in the prevention of microvascular obstruction (MVO) during a primary percutaneous coronary intervention (pPCI).
  
  
  BACKGROUND
  A head-to-head comparison between verapamil and SNP in the prevention of MVO lacks evidence.
  
  
  METHODS
  Sixty patients with ST-segment elevation myocardial infarction were randomized to receive IC verapamil (n=30) versus SNP (n=30) during pPCI. The primary outcome was the incidence of angiographic MVO as defined by Thrombolysis In Myocardial Infarction flow less than 3 or Thrombolysis In Myocardial Infarction flow 3 with myocardial blush grade less than 2. The secondary outcomes were the percentage of ST-segment resolution on 12-lead ECG, left ventricular ejection fraction and wall motion score index by two-dimensional echocardiography at 3-5 days after pPCI, as well as major adverse cardiovascular events at 30 days. Safety outcomes were the incidence of hypotension and/or bradycardia during pPCI.
  
  
  RESULTS
  Verapamil was associated with lower incidence of angiographic MVO compared with SNP (13.3 vs. 40%, respectively; P=0.02), as well as superior ST-segment resolution greater than or equal to 70% (33.3 vs. 6.7%, respectively; P=0.01). There was a trend towards improved left ventricular ejection fraction with verapamil (42.6±4.9 vs. 40.4±4.7%, respectively; P=0.09), but with similar wall motion score index (1.43±0.1 vs. 1.45±0.2, respectively; P=0.14). Both groups had similar 30-day major adverse cardiovascular events (3.3 vs. 6.7%, respectively; P=0.55). Verapamil was associated with lower incidence of hypotension compared with SNP (3.3 vs. 20%, respectively; P=0.04).
  
  
  CONCLUSIONS
  In pPCI, IC verapamil results in significant improvements in MVO with a better safety profile compared with SNP. Larger trials should be conducted to confirm these results.
authors.affiliation: aDepartment of Cardiovascular Medicine, Lancashire Cardiac Centre, Blackpool Teaching Hospital NHS Foundation Trust, Blackpool, UK bDepartment of Cardiovascular Medicine, Ain Shams University Medical School, Cairo, Egypt cDepartment of Medicine, Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
authors.forename: Hesham K
authors.initials: HK
authors.lastname: Abdelaziz
authors.forename: Wael
authors.initials: W
authors.lastname: Elkilany
authors.forename: Said
authors.initials: S
authors.lastname: Khalid
authors.forename: Sameh
authors.initials: S
authors.lastname: Sabet
authors.forename: Marwan
authors.initials: M
authors.lastname: Saad
mesh_terms: D017023:Coronary Angiography; D003326:Coronary Circulation / Q000187:drug effects; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000503:physiopathology; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D008297:Male; D008833:Microcirculation / Q000187:drug effects; D055806:Microvessels / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000503:physiopathology; D008875:Middle Aged; D009599:Nitroprusside / Q000009:adverse effects / Q000627:therapeutic use*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000401:mortality; D011446:Prospective Studies; D020127:Recovery of Function; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D013318:Stroke Volume / Q000187:drug effects; D013997:Time Factors; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016277:Ventricular Function, Left / Q000187:drug effects; D014700:Verapamil / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D014665:Vasodilator Agents; D009599:Nitroprusside; D014700:Verapamil