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

الملخص EN

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.