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Angiographic thrombolysis in myocardial infarction (TIMI) flow grade≤2 after primary percutaneous coronary intervention (PCI), defined as angiographic no-reflow, predicts poor functional recovery in patients with acute myocardial infarction. We investigated the effect of verapamil on the restoration of myocardial perfusion and functional recovery in patients with angiographic no-reflow after PCI.99mTc tetrofosmin single photon emission computed tomographic (SPECT) imaging was performed (before, immediately after and 1 month after PCI) in 101 consecutive patients with acute myocardial infarction. The defect score was calculated as the sum of perfusion defect in a 13-segment model (scores of 3, complete defect to 0, normal perfusion). The asynergic score, defined as the number of asynergic segments, was assessed by echocardiography before and 1 month later. Multiple logistic regression analysis was performed to elucidate the effect of verapamil administration.Of 101 patients, 32 (31%) had angiographic no-reflow and were divided into two groups: 18 patients with verapamil (group 1) and 14 patients without verapamil (group 2). Sixty-nine patients had TIMI grade 3 reflow after PCI (group 3). The change in the defect score 1 month after PCI in group 1 was significantly larger than that in group 2 (P=0.003). The asynergic score improved more at 1 month in group 1 compared to that in group 2 (P=0.007). Moreover, logistic regression analysis revealed that TIMI grade reflow ≤2 after PCI (P=0.04, OR=5.51), the defect score before PCI (P=0.03, OR=1.15), the asynergic score before PCI (P=0.01, OR=0.64) and the administration of verapamil (P=0.002, OR=22.4) were independently associated with successful myocardial reperfusion immediately after PCI.Intracoronary verapamil restored myocardial perfusion in patients with angiographic no-reflow after PCI and lead to better functional recovery after acute myocardial infarction.