Chest
Clinical InvestigationsEarly Administration of Intracoronary Verapamil Improves Myocardial Perfusion During Percutaneous Coronary Interventions for Acute Myocardial Infarction
Section snippets
Materials and Methods
From September 2001 to December 2003, 50 patients ready to undergo direct PCI within 12 h from the onset of AMI were prospectively and consecutively enrolled to receive intracoronary verapamil treatment. Intracoronary verapamil, 50 to 100 μg, was administered just before the guidewire was advanced through the infarct-related vessel with TIMI flow grade > 0, just after guidewire was advanced through the distal portion of the totally occluded infarct-related vessel and, if improved TIMI flow
Angiographic Definitions
TIMI flow grade was classified into grade 0 (no flow), grade 1 (penetration without perfusion), grade 2 (partial perfusion), or grade 3 (complete perfusion). To objectively evaluate an index of coronary flow as a continuous quantitative variable, the number of cineframes required for contrast to first reach standardized distal coronary landmarks in the infarct-related artery (the TIMI frame count) was measured with a frame counter on the cineviewer (25 frames per second). A CTFC < 14 was
Statistical Analysis
Data are presented as mean ± SD unless otherwise noted. Differences between the two groups were examined by two-tailed Student t test, χ2, and exact Mann-Whitney U rank test where appropriate. Variables entered into the logistic models were those with a univariate probability value of p < 0.20. Multivariate logistic models were used to identify the independent predictors of TMPG; p < 0.05 was considered significant.
Results
Between September 2001 and December 2003, 50 consecutive patients undergoing direct PCI within 12 h from the onset of AMI were prospectively enrolled in the study. None of these patients received platelet glycoprotein IIb/IIIa inhibitors during the procedure. From August 2000 to August 2001, 50 consecutive patients who had undergone direct PCI within 12 h from onset of AMI and who had not received intracoronary calcium-channel blockers or platelet glycoprotein IIb/IIIa inhibitors were
Angiographic Analysis
Both groups had similar pre-PCI and post-PCI thrombus scores and TIMI flow grades, post-PCI CTFC, and post-PCI TIMI grade 3 flow (90% vs 84%, respectively) [Table 2]. The patients treated with intracoronary verapamil had significantly higher TMPG than the control subjects (p = 0.003) [Table 2]. TMPG-3 was observed in 21 of the patients (42%) who received intracoronary verapamil and in 7 of the control subjects (14%) who did not (p = 0.004) [Table 2].
Univariate analysis showed that the pre-PCI
Clinical Outcomes
One month clinical follow-up data for all patients can be found in Table 4. The patients treated with verapamil had no major adverse in-hospital cardiac events, including death, coronary artery bypass surgery, myocardial infarction, or revascularization. The control group had three in-hospital deaths. One of the patients who died was found to have neurologic deficits during the PCI procedure and died within 24 h due to brainstem stroke and heart failure. Another patient died of recurrent
Discussion
AMI no-reflow phenomenon is associated with profound and broad myocardial damage, progressive left ventricular dilatation, and a high frequency of post-AMI complications.451112192021 Multiple factors (eg, microvascular spasm, endothelial cell damage, tissue edema, platelet aggregation, and neutrophil, clot, and atheromatous plaque plugging of the microvessels) contribute to the development of AMI no-reflow phenomenon.12142223242526272829 Intracoronary calcium-channel blockers have been shown to
Conclusion
Early administration of intracoronary verapamil during direct PCI improves postprocedural myocardial perfusion as evaluated by TMPG.
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