Short-Term Effects of Verapamil and Diltiazem in the Treatment of No Reflow Phenomenon: A Meta-Analysis of Randomized Controlled Trials

Abstract

Currently, there is still a lack of an optimal treatment for no reflow phenomenon (NRP). We analyzed the efficacy and safety of using nondihydropyridine calcium channel antagonists (NDHP, verapamil/diltiazem) in patients suffering from NRP. Eight RCTs with 494 participants were eligible for analysis. The pooling analysis showed that intracoronary verapamil/diltiazem injection significantly decreased the occurrence of the coronary NRP (RR: 0.3, 95% CI: 0.16–0.57; P = 0.0002) and reduced corrected thrombolysis in myocardial infarction (TIMI) frame Count (WMD = −9.24, 95% CI −13.91–4.57; P = 0.0001) in patients with NRP. Moreover, verapamil/diltiazem treatment showed superiority in reducing wall motion index (WMI) compared to the control at day 1 (WMD = 0.11, 95% CI: 0.02–0.20; P = 0.02) (P < 0.05). There was also a significantly greater decline at occurrence of the major adverse cardiac events between verapamil/diltiazem and control groups (WMD: 0.4, 95% CI: 0.19–0.84; P = 0.02). However, using verapamil/diltiazem did not provide additional improvement of left ventricular ejection fraction post procedure (at 7 days, WMD, 0.1; 95% CI, −2.43–2.63; P = 0.94; at 30 days, WMD, 0.42; 95% CI, −2.09–2.92; P = 0.75). NDHP use is beneficial in attenuating NRP and reducing 6-month MACEs in patients with NRP.

Acute Effects of Particulate Air Pollution on the Incidence of Coronary Heart Disease in Shanghai, China

“…Studies have reported a reduced risk of death associated with early treatment with nitroglycerin [ 19 , 20 ]. Verapamil and diltiazem, as vasodilators, can restore coronary artery flow and myocardial perfusion efficiently [ 21 , 22 ]. Beta-blocker therapy has been recommended in the course of MI for patients who are not at high risk for complications.…”

Intracoronary focal nitroglycerin injection through drilled balloon is very effective in the resolution of coronary spasm versus into proximal coronary artery: A prospective randomized comparison study

“…Both drugs were found to be efficient in addressing no reflow. However, we found no publication on “local NTG” for an application addressing coronary spasm …”

Coronary microvascular obstruction (the no-reflow phenomenon) during percutaneous coronary interventions in patients with myocardial infarction

“…Еще одним вариантом кардиопротекции является ишемическое коронарное посткондиционирование, суть которого заключается в проведении серии циклических раздуваний баллона в просвете КА непосредственно после имплантации стента и восстановления [28] • Минимально инвазивная стратегия у избранных пациентов (П М) [32,33] • Ишемическое посткондиционирование (П М К) [34,35] • Механическая тромбэктомия (П М) [2] • Эксенатид, лираглутид (П) [36] • Оксид азота (П) [37] • Блокаторы кальциевых каналов (П М) [38] • Предсердный натрийуретический пептид (П) [36] • Гипотермия (П) [28] • Аденозин (П М) [39] • Прерывистая окклюзия коронарного синуса (П) [40] • Эксенатид, лираглутид (П) [36] • Предсердный натрийуретический пептид (П) [36] • Гипотермия (П) [28] • Аденозин (П М) [39] • Цилостазол (П) [42] Не рекомендовано…”