REstoration of COronary flow in patients with no-reflow after primary coronary interVEntion of acute myocaRdial infarction (RECOVER).

Abstract

BACKGROUND:

No randomized trial has been conducted to compare different vasodilators for treating no-reflow during primary percutaneous coronary intervention (PCI) for ST-segment elevation acute myocardial infarction.

METHODS:

The prospective, randomized, 2-center trial was designed to compare the effect of 3 different vasodilators on coronary no-reflow. A total of 102 patients with no-reflow in primary PCI were randomized to receive intracoronary infusion of diltiazem, verapamil, or nitroglycerin (n = 34 in each group) through selective microcatheter. The primary end point was coronary flow improvement in corrected thrombolysis in myocardial infarction frame count (CTFC) after administration of the drug.

RESULTS:

Compared with that of the nitroglycerin group, there was a significant improvement of CTFC after drug infusion in the diltiazem and verapamil groups (42.4 frames vs 28.1 and 28.4 frames, P < .001). The improvement in CTFC was similar between the diltiazem and verapamil groups (P = .9). Compared with the nitroglycerin group, the diltiazem and verapamil groups had more complete ST-segment resolution at 3 hours after PCI, lower peak troponin T level, and lower N-terminal pro-B-type natriuretic peptide levels at 1 and 30 days after PCI. After drug infusion, the drop of heart rate and systolic blood pressure in the verapamil group was greater than that in the diltiazem and nitroglycerin groups.

CONCLUSION:

Intracoronary infusion of diltiazem or verapamil can reverse no-reflow more effectively than nitroglycerin during primary PCI for acute myocardial infarction. The efficacy of diltiazem and verapamil is similar, and diltiazem seems safer.

• Authors: Dong Huang, Juying Qian, Lei Ge, Xuejuan Jin, Huigen Jin, Jianying Ma, Zongjun Liu, Feng Zhang, Lili Dong, Xiangfei Wang, Kang Yao, Junbo Ge
• Journal: American heart journal (Am Heart J) Vol. 164 Issue 3 Pg. 394-401 (Sep 2012) ISSN: 1097-6744 [Electronic] United States
• PMID: 22980307 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial)
• Copyright: Copyright © 2012 Mosby, Inc. All rights reserved.

Chemical References

• Troponin T
• Vasodilator Agents
• Natriuretic Peptide, Brain
• Verapamil
• Diltiazem
• Nitroglycerin

Topics

• Aged
• Coronary Circulation (drug effects, physiology)
• Diltiazem (administration & dosage, adverse effects)
• Electrocardiography
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Myocardial Infarction (drug therapy, physiopathology)
• Natriuretic Peptide, Brain (blood, drug effects)
• Nitroglycerin (administration & dosage, adverse effects)
• Percutaneous Coronary Intervention
• Prospective Studies
• Treatment Outcome
• Troponin T (blood, drug effects)
• Vasodilator Agents (administration & dosage, adverse effects)
• Verapamil (administration & dosage, adverse effects)