Short-term effect of verapamil on coronary no-reflow associated with percutaneous coronary intervention in patients with acute coronary syndrome: a systematic review and meta-analysis of randomized controlled trials

Abstract

Background: To evaluate the clinical efficacy and safety of intracoronary verapamil injection in the prevention and treatment of coronary no-reflow after percutaneous coronary intervention (PCI).

Hypothesis: Intracoronary verapamil injection may be beneficial in preventing no-reflow/slow-flow after PCI.

Methods: We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials database. Randomized trials comparing the efficacy and safety of intracoronary verapamil infusion vs control in patients with acute coronary syndrome (ACS) were included. Meta-analysis was performed by RevMan 5.0 software (Cochrane Collaboration, Copenhagen, Denmark) .

Results: Seven trials involving 539 patients were included in the analysis. Verapamil treatment was significantly more effective in decreasing the incidence of no-reflow (risk ratio [RR]: 0.33; 95% confidence interval [CI]: 0.23 to 0.50) as well as reducing the corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC) (weighted mean difference: -11.62; 95% CI: -16.04 to -7.21) and improving the TIMI myocardial perfusion grade (TMPG) (RR: 0.43; 95% CI: 0.29 to 0.64). Verapamil also reduced the 30-day wall motion index (WMI) compared to the control. Moreover, the procedure reduced the incidence of major adverse cardiac events (MACEs) in ACS patients during hospitalization (RR: 0.37; 95% CI: 0.17 to 0.80) and 2 months after PCI (RR: 0.56; 95% CI: 0.33 to 0.95). However, administration of verapamil did not provide an additional improvement of left ventricular ejection fraction regardless of the time that had passed post-PCI.

Conclusions: Intracoronary verapamil injection is beneficial in preventing no-reflow/slow-flow, reducing CTFC, improving TMPG, and lowering WMI. It is also likely to reduce the 2-month MACEs in ACS patients post-PCI.

© 2013 Wiley Periodicals, Inc.

Figures

Figure 1

Flow chart of study selection.

Figure 2

Pooled risk ratio of verapamil therapy vs control for no‐flow/slow‐flow after percutaneous coronary intervention. Abbreviations: CI, confidence interval; M‐H, Mantel‐Haenszel.

Figure 3

Pooled mean difference of verapamil therapy vs control for correct thrombolysis in myocardial infarction frame count after percutaneous coronary intervention. Abbreviations: CI, confidence intervals; IV, inverse variance; SD, standard deviation.

Figure 4

Pooled risk ratio of verapamil therapy vs control for TIMI myocardial perfusion grade (TMPG) after percutaneous coronary intervention. Abbreviations: CI, confidence interval; M‐H, Mantel‐Haenszel; TIMI, thrombolysis in myocardial infarction.

Figure 5

Pooled mean difference of verapamil therapy vs control for left ventricular ejection fraction (LVEF) after percutaneous coronary intervention (PCI). Abbreviations: CI, confidence intervals; IV, inverse variance; SD, standard deviation.

Figure 6

Pooled risk ratio of verapamil therapy vs control for major adverse cardiac events after percutaneous coronary intervention. Abbreviations: CI, confidence interval; M‐H, Mantel‐Haenszel.

Figure 7

Funnel plot assessing publication bias of the included studies. Abbreviations: RR, risk ratio; SE, standard error.