Effect of intracoronary anisodamine and diltiazem administration during primary percutaneous coronary intervention in acute myocardial infarction.

Objective: The aim of this study was to examine the role of intracoronary anisodamine and diltiazem administration performed before stenting on the immediate angiographic and clinical outcome in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).

Methods: STEMI patients during primary PCI were randomized to two bolus injections of intracoronary anisodamine (1 mg/5 ml) and diltiazem (2 mg/5 ml) (COM group, n=54) or saline (5 ml) and diltiazem (2 mg/5 ml) (diltiazem group, n=54) before stenting. The primary endpoint was the incidence of no/slow reflow [thrombolysis in myocardial infarction (TIMI) flow grade≤2] immediately after stenting. TIMI myocardial perfusion grade and corrected TIMI frame count were assessed. The secondary endpoints were major adverse cardiac events including death, nonfatal myocardial infarction, and target vessel revascularization.

Results: The percent of TIMI flow grade 3 was found to be higher in the COM group than in the diltiazem group (92.6 vs. 75.9%, P=0.032). The percent of TIMI myocardial perfusion grade 3 was 46.3% in the diltiazem group and improved in the COM group (68.5%, P=0.032). Corrected TIMI frame count was significantly lower in the COM group than in the diltiazem group (P<0.0001). The COM group showed low incidences of bradyarrhythmia and rapid arrhythmia (7.4 vs. 24.1% and 3.7 vs. 18.5%, respectively, P=0.032, P=0.029). In addition, there were no significant differences in the secondary outcome measures.

Conclusion: Intracoronary anisodamine and diltiazem administration before stenting improved the angiographic results and prevented reperfusion arrhythmia in patients with STEMI undergoing PCI.