Efficacy of Verapamil Injection into the Saphenous Vein Graft Before Percutaneous Coronary Intervention in Preventing Slow-Flow and No-Reflow

Background: Degenerative plaques in the saphenous vein graft (SVG) are prone to embolization during percutaneous coronary intervention (PCI), resulting in the slow-flow or no-reflow phenomenon and unfavorable PCI outcomes. Methods: This prospective cohort study was conducted on 63 patients who underwent PCI on the SVG divided into 2 groups. The case group (n=32) received 200 μg of verapamil injection into the SVG before PCI, and the control group (n=31) did not receive verapamil. The primary endpoints comprised slow-flow or no-reflow, the thrombolysis in myocardial infarction (TIMI) flow grade, the TIMI frame count, and the TIMI myocardial perfusion grade after PCI. The secondary endpoints consisted of unstable angina and major adverse cardiac events, defined as a composite of total death, ST-segment or non–ST-segment elevation myocardial infarction, cerebrovascular accident, hospitalization due to heart failure, and revascularization (PCI and coronary artery bypass grafting) during hospitalization and a 3-month follow-up. Results: The patients who received verapamil injection, compared with the control group, had significantly low rates of slow-flow and no-reflow (4.8% vs 17.5%; P=0.01) and favorable TIMI frame counts (46% vs 12%; P 0.01), TIMI flow grades (31.7% vs 14.3%; P=0.015), and TIMI myocardial perfusion grades (34.9% vs 9.5%; P=0.001). There were no differences in the secondary outcomes during both hospital stay and the 3-month follow-up. Conclusions: Our study demonstrated that verapamil injection into the SVG before PCI significantly decreased the rate of postprocedural slow-flow and no-reflow and conferred favorable TIMI flow grades, TIMI frame counts, and TIMI myocardial perfusion grades.