EFFICACY OF INTRACORONARY ADENOSINE AND VERAPAMIL IN NO-REFLOW AMONG NORMOTENSIVE PATIENTS PRESENTING WITH ACUTE CORONARY SYNDROME

Abstract

Objective: To compare the efficacy of intracoronary adenosine and verapamil in improving myocardial perfusion in normotensive patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). Study Design: This was a prospective observational study. Place and Duration: This study was conducted at Chandka Medical College Hospital Larkana, while the cath procedures were performed at (SICVD) Larkana from February 2025 to February 2026. Methods: A total of 120 normotensive patients with ACS undergoing PCI were enrolled and equally allocated into 2 groups. The adenosine group (n=60) received intracoronary adenosine, while the verapamil group (n=60) received intracoronary verapamil. Post-procedural Thrombolysis in Myocardial Infarction (TIMI) flow grade was the primary outcome variable. Secondary outcomes included a 6-month major adverse cardiac events (MACE), Index of Microcirculatory Resistance (IMR), and flow-mediated dilatation (FMD). Independent-samples t-test and chi-square test were used for analysis, with p<0.05 considered significant. Results: Baseline variables were comparable between groups. Mean age was 60.0 ± 7.0 years in the adenosine group and 58.0 ± 6.0 years in the verapamil group (p=0.34). Male participants accounted for 48.3% and 53.3%, respectively (p=0.57). Post-treatment TIMI flow was significantly higher in the verapamil group than in the adenosine group (2.9 ± 0.4 vs 2.6 ± 0.5, p=0.02). Post-procedural IMR was lower in the adenosine group (18.0 ± 2.0 vs 20.0 ± 3.0, p=0.08), while post-procedural FMD was higher in the verapamil group (4.3 ± 0.6 vs 4.0 ± 0.7, p=0.12). At 6 months, MACE was lower in the adenosine group (11.7% vs 23.3%, p>0.05). Conclusion: Intracoronary verapamil showed superior immediate improvement in TIMI flow, while adenosine demonstrated a favorable trend in IMR and lower 6-month MACE. However, neither drug was consistently superior across all outcomes.