Forthcoming

Comparison of Intracoronary Verapamil and Adenosine for No-Reflow in Normotensive Patients with Acute Coronary Syndrome: A Prospective Observational Study

Authors

  • Qazi Najeeb Ullah Amin Hayatabad Medical Complex, Peshawar, Pakistan
  • Muhammad Abdur Rauf Kuwait Teaching Hospital Peshawar, Pakistan
  • Syed Hashim Ali Shah Hayatabad Medical Complex, Peshawar, Pakistan
  • Sami Ullah Shakir National Institute of Cardiovascular Diseases, Karachi, Pakistan
  • Syed Kashif Ullah Shah Hayatabad Medical Complex, Peshawar, Pakistan
  • Arshad Ali National Institute of Cardiovascular Diseases, Karachi, Pakistan
  • Nasir Ali Hayatabad Medical Complex, Peshawar, Pakistan

Abstract

Objectives: This study aimed to compare the efficacy of intracoronary verapamil versus adenosine in managing the no-reflow phenomenon in normotensive patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).

Methodology: We conducted a prospective observational study at Hayatabad Medical Complex Peshawar from March 2023 to March 2024. A total of 150 normotensive ACS patients scheduled for PCI were enrolled and treated with either intracoronary verapamil (200 µg) or adenosine (48 µg) based on the clinical judgment of the treating cardiologist upon identifying the no-reflow phenomenon. The primary outcomes included improvements in myocardial perfusion, assessed by the achievement of TIMI III flow immediately and at 30 minutes via angiographic analysis. Secondary outcomes assessed were microvascular resistance (IMR), endothelial function (FMD), and the incidence of major adverse cardiac events (MACE) within six months.

Results: The verapamil group exhibited a higher percentage of patients achieving TIMI III flow post-treatment compared to the adenosine group (92% vs. 78%, p = 0.03). Both treatment groups demonstrated reductions in IMR (verapamil: 18.5 ± 2.8 units; adenosine: 19.1 ± 3.1 units, p = 0.29) and improvements in FMD (verapamil: 4.1 ± 0.5%; adenosine: 3.9 ± 0.6%, p = 0.15). The incidence of MACE was 18% in the verapamil group and 8% in the adenosine group, indicating comparable safety profiles for both agents.

Conclusion: Intracoronary verapamil and adenosine both effectively enhance myocardial perfusion and endothelial function in normotensive ACS patients following PCI. Verapamil showed a slight advantage in achieving TIMI III flow and reducing microvascular resistance, suggesting it may offer superior benefits in specific clinical scenarios. These results support the use of both agents in managing the no-reflow phenomenon, with potential preference for verapamil in particular contexts.

Downloads

Download data is not yet available.

Downloads

Published

2024-10-18

How to Cite

1.
Amin QNU, Rauf MA, Shah SHA, Shakir SU, Shah SKU, Ali A, Ali N. Comparison of Intracoronary Verapamil and Adenosine for No-Reflow in Normotensive Patients with Acute Coronary Syndrome: A Prospective Observational Study. Pak Heart J [Internet]. 2024Oct.18 [cited 2024Nov.24];. Available from: https://pakheartjournal.com/index.php/pk/article/view/2787

Issue

Ahead of Print

Section

Original Article

License

Copyright (c) 2021 Pakistan Heart Journal

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

When an article is accepted for publication in the print format, the author will be required to transfer exclusive copyright to the PHJ and retain the rights to use and share their published article with others. However, re-submission of the full article or any part for publication by a third party would require prior permission of the PHJ.

Online publication will allow the author to retain the copyright and share the article under the agreement described in the licensing rights with creative commons, with appropriate attribution to PHJ. Creative Commons attribution license CC BY 4.0 is applied to articles published in PHJ https://creativecommons.org/licenses/by/4.0/