Nitroglycerin plus diltiazem versus nitroglycerin alone for spasm prophylaxis with transradial approach.

Objectives: The aim of this study was to compare the efficacy of nitroglycerin and diltiazem versus nitroglycerin alone in preventing radial artery spasm (RAS) during transradial coronary procedures.

Background: Spasm after transradial access decreases procedural success. Multiple spasmolytics are used to prevent spasm. Individual efficacy of these agents is not conclusively established.

Methods: One hundred and fifty patients undergoing coronary procedures through radial artery were enrolled and divided into two groups of 75 patients each. Patients in Group A received 200 μg nitroglycerin plus 2.5 mg diltiazem intra-arterially, and group B patients received 200 μg nitroglycerin plus placebo (saline). Blood pressure (BP) and heart rate (HR) were recorded at baseline and for 5 minutes after cocktail was given. Clinical signs of RAS, such as pain and resistance during catheter maneuver, were recorded in both groups during the procedure.

Results: Systolic and diastolic BP decreased significantly in Group A compared to Group B after cocktail was given (P<.001 and P<.022, respectively). There were no significant changes of HR in either group. There was no significant difference in the incidence of clinical RAS between Group A (diltiazem plus nitroglycerin) versus Group B (nitroglycerin alone) (5% vs 7%; P=1.000). Furthermore, we found higher incidence of local burning pain in the forearm in patients that receive intra-arterial diltiazem plus nitroglycerin compared to nitroglycerin alone (21% vs 9%; P=.041).

Conclusion: Diltiazem plus nitroglycerin showed no advantage compared to nitroglycerin alone in prevention of RAS in transradial approach.